Characterization of arrhythmia substrate to ablate persistent atrial fibrillation (COAST-AF): Randomized controlled...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial low voltage area (LVA) catheter ablation is a potential treatment for persistent atrial fibrillation (AF).
• The efficacy of adding LVA ablation to pulmonary vein isolation (PVI) for persistent AF is not well-established.

Purpose of the Study:

• To determine if adjunctive atrial LVA ablation with PVI improves treatment success compared to PVI alone in persistent AF patients.
• To evaluate safety, quality of life, and healthcare resource utilization as secondary outcomes.

Main Methods:

• A multicenter, randomized controlled trial (NCT03347227) comparing PVI alone versus PVI plus atrial LVA ablation.
• 18-month assessment of documented atrial arrhythmia recurrence (AF, atrial tachycardia, atrial flutter) as the primary outcome.
• Secondary outcomes include complications, arrhythmia freedom at 12 months, AF burden, and quality of life.

Main Results:

• Data collection is ongoing; results are pending.
• The study is designed to provide robust evidence on the primary and secondary endpoints.

Conclusions:

• The Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) trial will elucidate the effectiveness of combined LVA and PVI ablation.
• Higher procedural success rates are hypothesized for the combined strategy compared to PVI alone in persistent AF.