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Updated: Nov 26, 2025

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PRECAF Randomized Controlled Trial.

Ling Kuo1,2, David S Frankel2, Aung Lin2

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Summary
This summary is machine-generated.

Ablating coronary sinus (CS) to left atrial (LA) connections during a first atrial fibrillation (AF) ablation significantly reduced arrhythmia recurrence. This CS-LA connection elimination strategy shows promise for improving AF management.

Keywords:
atrial fibrillationcoronary sinusechocardiographypulmonary veinrecurrence

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Interventions

Background:

  • Dual muscular coronary sinus (CS) to left atrial (LA) connections, with rate-dependent block, are linked to atrial fibrillation (AF) induction.
  • Previous research established the association between these CS-LA connections and AF.
  • The clinical impact of ablating these specific connections in first-time AF ablation remains to be fully elucidated.

Purpose of the Study:

  • To investigate if ablating distal CS to LA connections during a first AF ablation procedure can decrease the rate of arrhythmia recurrence.
  • To evaluate the efficacy of an adjunctive ablation strategy targeting CS-LA connections.

Main Methods:

  • A single-center randomized controlled trial included 35 patients with drug-refractory AF undergoing their first ablation.
  • Patients were randomized to either standard ablation (pulmonary vein isolation and non-pulmonary vein trigger ablation) or standard ablation plus elimination of distal CS to LA connections.
  • Elimination of CS-LA connections was guided by targeting earliest LA activation during distal CS pacing, confirmed by electrogram changes.

Main Results:

  • After a mean follow-up of 170 days, 30 patients completed the study.
  • The CS-LA connection elimination group experienced significantly fewer atrial arrhythmia recurrences (6.7%) compared to the standard ablation group (46.7%).
  • The hazard ratio for recurrence was 0.12 (P=0.047), favoring the intervention group.

Conclusions:

  • Elimination of distal CS to LA connections, when added to standard ablation, significantly reduced atrial arrhythmia recurrences in patients undergoing their first AF ablation.
  • This targeted ablation strategy appears effective in a small randomized study.
  • Further validation in multicenter randomized trials is warranted to confirm these findings.