Voltage-guided posterior wall ablation beyond PVI in persistent AF improved 5-year atrial tachyarrhythmia/AF-free survival compared to standard ablation (64% vs 34%; HR 0.358, p<0.005).
Cohort (n=152)
Does voltage-guided ablation of the posterior wall improve 5-year arrhythmia-free survival compared to standard ablation in patients with persistent atrial fibrillation?
Voltage-guided posterior wall ablation significantly improves 5-year arrhythmia-free survival in persistent AF compared to non-voltage-guided ablation, reducing AF recurrence without the higher incidence of AT seen with empiric posterior wall ablation.
Effect estimate: HR 0.358
Absolute Event Rate: 64% vs 34%
p-value: p=<0.005
INTRODUCTION: The posterior wall (PW) has been proposed as a standard target for ablation beyond pulmonary vein antral isolation (PVI) in patients with persistent atrial fibrillation (AF). However, studies have shown inconsistent outcomes with the addition of PW ablation. The presence or absence of low voltage on the PW may explain these inconsistencies. We evaluated whether PW ablation based on the presence or absence of low voltage improves long-term arrhythmia-free outcomes. METHODS: We retrospectively reviewed 5-year follow-up in 152 consecutive patients who received either standard ablation (SA) with PVI alone or PVI + PW ablation (PWA) based on physician discretion (n = 77) or voltage-guided ablation (VGA) with PVI and addition of PWA only if low voltage was present on the PW (n = 75). RESULTS: The two groups were well matched for baseline characteristics. At 5-year follow-up, 64% of patients receiving VGA were atrial tachyarrhythmia (AT)/AF free compared to 34% receiving SA (HR 0.358 p < .005). PWA had similar AF recurrence in SA and VGA groups (0.30 vs. 0.27 p = .96) but higher AT recurrence when comparing SA and VGA groups (0.39 vs. 0.15 p = .03). In multivariate analysis, both VGA and PWA predicted AF arrhythmia-free survival (HR 0.33, p = .001 and HR 0.20, p = .008, respectively). For AT, VGA predicted arrhythmia-free survival (HR 0.22, p = .028), while PWA predicted AT recurrence (HR 4.704, p = .0219). CONCLUSION: VGA of the posterior wall ablation beyond PVI in persistent AF significantly improves long-term arrhythmia-free survival when compared with non-voltage-guided ablation. PW ablation without voltage-guidance reduced AF recurrence but at the cost of a higher incidence of AT.
Cutler et al. (Fri,) conducted a cohort in Persistent atrial fibrillation (n=152). Voltage-guided ablation (VGA) with PVI and addition of PWA only if low voltage was present vs. Standard ablation (SA) with PVI alone or PVI + PWA based on physician discretion was evaluated on Atrial tachyarrhythmia (AT)/AF free survival (HR 0.358, p=<0.005). Voltage-guided posterior wall ablation beyond PVI in persistent AF improved 5-year atrial tachyarrhythmia/AF-free survival compared to standard ablation (64% vs 34%; HR 0.358, p<0.005).