Key result
COAST-AF evaluates adjunctive low-voltage area ablation versus PVI alone for persistent AF.
Why the study?
Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for persistent AF, but it remains unclear whether adding atrial LVA ablation to pulmonary vein isolation (PVI) increases treatment success rates compared to PVI alone.
Does adjunctive catheter ablation of atrial low voltage areas in addition to pulmonary vein isolation reduce 18-month atrial arrhythmia recurrence compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation?
RCT
Single-blind
1:1
Yes
Does adjunctive catheter ablation of atrial low voltage areas in addition to pulmonary vein isolation reduce 18-month atrial arrhythmia recurrence compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation?
This study protocol outlines the COAST-AF randomized controlled trial designed to determine whether adding atrial low voltage area ablation to standard pulmonary vein isolation improves 18-month arrhythmia-free survival in persistent atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Adjunctive low-voltage ablation remains unproven in persistent AF; COAST-AF leaves open any benefit over PVI alone.
BACKGROUND Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for ablation of persistent atrial fibrillation (AF). It is unclear if catheter ablation of atrial LVA increases treatment success rates in patients with persistent AF. OBJECTIVE The primary aim of this trial is to assess the potential benefit of adjunctive catheter ablation of atrial LVA in addition to pulmonary vein isolation (PVI) in patients with persistent AF, when compared to PVI alone. The secondary aims are to evaluate safety outcomes, quality of life and healthcare resource utilization. METHODS/DESIGN A multicenter, prospective, parallel-group, two-arm, single-blinded randomized controlled trial is under way (NCT03347227). Patients who are candidates for catheter ablation for persistent AF will be randomly assigned (1:1) to either PVI alone or PVI + atrial LVA ablation. The primary outcome is 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Secondary outcomes include procedure-related complications, freedom from atrial arrhythmia at 12 months, AF burden, need for emergency department visits/hospitalization, need for repeat ablation for atrial arrhythmia, quality of life at 12 and 18 months, ablation time, and procedure duration. DISCUSSION Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) is a multicenter randomized trial evaluating ablation strategies for catheter ablation. We hypothesize that catheter ablation of atrial LVA in addition to PVI will result in higher procedural success rates when compared to PVI alone in patients with persistent AF.
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Nery et al. (2022) conducted an RCT in Persistent atrial fibrillation. Pulmonary vein isolation plus atrial low voltage area catheter ablation vs. Pulmonary vein isolation alone was evaluated on 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Adjunctive atrial low voltage area ablation added to PVI is being evaluated against PVI alone in persistent AF in the ongoing COAST-AF trial (no results reported).
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