Electrophysiological test-guided adjunctive posterior wall isolation reduced atrial fibrillation or atrial tachycardia recurrence in patients with persistent AF without low-voltage areas (P=0.01).
RCT (n=144)
Does EP test-guided adjunctive left atrial posterior wall isolation reduce AF/AT recurrence in patients with persistent atrial fibrillation without a left atrial low-voltage area?
EP test-guided adjunctive posterior wall isolation may reduce atrial fibrillation or atrial tachycardia recurrences in patients with persistent AF without low-voltage areas.
p-value: p==0.01
BACKGROUND: Electrical remodeling precedes structural remodeling. In adjunctive left atrial (LA) low-voltage area (LVA) ablation to pulmonary vein isolation of atrial fibrillation (AF), LA areas without LVA have not been targeted for ablation. We studied the effect of adjunctive LA posterior wall isolation (PWI) on persistent AF without LA-LVA according to electrophysiological testing (EP test). METHODS: We examined consecutive patients with persistent AF with (n=33) and without (n=111) LA-LVA. Patients without LA-LVA were randomly assigned to EP test-guided (n=57) and control (n=54) groups. In the EP test-guided group, an adjunctive PWI was performed in those with positive results (PWI subgroup; n=24), but not in those with negative results (n=33). The criteria for positive EP tests were an effective refractory period ≤180 ms, effective refractory period>20 ms shorter than the other sites, and/or induction of AF/atrial tachycardia (AT) during measurements. LVA ablation was performed in the patients with LA-LVA. RESULTS: =0.01). No significant differences in the recurrence and AF/AT-free survival curve rates between the PWI (positive EP test) and non-PWI (negative EP test) subgroups were observed. Therefore, PWI for positive EP tests reduced the AF/AT recurrence in the EP test-guided group. A stepwise Cox proportional hazard analyses identified EP test-guided ablation as a factor reducing the recurrence rate. The recurrence rates in the LA-LVA ablation group and EP test-guided group were similar. CONCLUSIONS: This pilot study proposed that an EP test-guided adjunctive PWI of persistent AF without LA-LVA potentially reduced AF/AT recurrences. The results suggest that there is an AF substrate in the LA with altered electrophysiological function even when there is no LA-LVA. Graphic Abstract: A graphic abstract is available for this article.
Yamaji et al. (Tue,) conducted a rct in Persistent atrial fibrillation without a left atrial low-voltage area (n=144). Electrophysiological test-guided left atrial posterior wall isolation vs. Control was evaluated on AF/AT recurrence (p==0.01). Electrophysiological test-guided adjunctive posterior wall isolation reduced atrial fibrillation or atrial tachycardia recurrence in patients with persistent AF without low-voltage areas (P=0.01).