Key result
Greater coronary sinus cycle length prolongation was independently associated with a lower risk of arrhythmia recurrence (HR 0.298; 95% CI 0.017-0.520; P<.001).
Why the study?
The benefit of additional left atrial posterior wall ablation beyond pulmonary vein isolation in persistent atrial fibrillation remains controversial, and predictors of arrhythmia-free survival after pulsed field ablation are unclear.
Does left atrial posterior wall activity or coronary sinus cycle length prolongation during pulsed field ablation predict arrhythmia-free survival in patients with persistent atrial fibrillation?
Observational (n=270)
Yes
Does left atrial posterior wall activity or coronary sinus cycle length prolongation during pulsed field ablation predict arrhythmia-free survival in patients with persistent atrial fibrillation?
Hazard Ratio: 0.298 (95% CI 0.017–0.52)
p-value: p=<.001
Coronary sinus cycle length prolongation >23.5% after left atrial posterior wall ablation is an independent predictor of arrhythmia-free survival and may serve as a real-time marker of effective substrate modification in persistent atrial fibrillation.
BACKGROUND: The benefit of additional left atrial posterior wall ablation (LAPWA), beyond pulmonary vein isolation (PVI), in the treatment of persistent atrial fibrillation (PersAF) remains controversial. OBJECTIVE: We investigated whether signals recorded with a pentaspline pulsed field ablation (PFA) catheter can identify patients with PersAF with rapid left atrial posterior wall (LAPW) activity who may benefit from LAPWA. We also evaluated whether PFA-induced atrial fibrillation cycle length prolongation predicts arrhythmia-free survival. METHODS: In this multicenter observational study, consecutive patients with PersAF undergoing first-time PVI plus LAPWA with a pentaspline PFA catheter were included. Atrial fibrillation cycle length was measured using the FARS-10 (10 consecutive Fastest Atrial Repetitive Similar morphology signal) method at 3 time points-baseline, after PVI, and after LAPWA-using distal coronary sinus signals. LAPW cycle length (LAPW-CL) was measured after PVI from multiple LAPW positions. Any atrial tachyarrhythmia (ATA) lasting >30 seconds beyond the 2-month blanking period were recorded. RESULTS: 270 patients were included. The overall 12-month ATA-free survival rate was 72.6%. "Fast LAPW activity" was defined as an LAPW-CL value shorter than the mean LAPW-CL of the entire cohort (191.4 ± 2.4 ms; ≤190 ms). Fast LAPW activity was not associated with arrhythmia recurrence (hazard ratio = 1.263, 95% confidence interval = 0.739-2.160; P = .393). In contrast, a greater coronary sinus cycle length (CS-CL) prolongation was independently associated with a lower arrhythmia recurrence risk (hazard ratio = 0.298, 95% confidence interval = 0.017-0.520; P < .001). A CS-CL increase >23.5% from baseline had a sensitivity of 0.65 and a specificity of 0.72 for predicting ATA-free survival. CONCLUSION: Post-PVI fast LAPW activity does not predict recurrence after LAPWA in patients with PersAF. CS-CL prolongation >23.5% after LAPWA may serve as a useful real-time marker of effective substrate modification and arrhythmia control.
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Bianchini et al. (2026) conducted an observational in Persistent atrial fibrillation (n=270). Greater coronary sinus cycle length (CS-CL) prolongation vs. Less CS-CL prolongation was evaluated on Arrhythmia recurrence (HR 0.298, 95% CI 0.017-0.520, p=<.001). Greater coronary sinus cycle length prolongation was independently associated with a lower risk of arrhythmia recurrence (HR 0.298; 95% CI 0.017-0.520; P<.001).
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