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Published on: May 26, 2015
Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent
Kaige Li1, Changhao Xu1, Xiyao Zhu2
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Shanghai 200030, China.
Insights
Extensive electro-anatomical guided ablation is most effective for persistent atrial fibrillation (PerAF) treatment. This strategy showed higher success rates and fewer recurrences compared to anatomical or electrogram-guided ablation.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Persistent atrial fibrillation (PerAF) management strategies require optimization.
- Current ablation techniques for PerAF have varying outcomes.
Purpose of the Study:
- To compare the efficacy of three distinct ablation strategies for persistent atrial fibrillation.
- To evaluate anatomical, electrogram, and extensive electro-anatomical guided ablation outcomes.
Main Methods:
- A multicentre, randomized, prospective trial involving 450 patients.
- Patients were assigned to anatomical (ANAT), electrogram (EGM), or extensive electro-anatomical (EXT) guided ablation.
- Primary endpoint: freedom from atrial fibrillation (AF) >30s at 12 months post-ablation.
Main Results:
- 72% of patients in the EXT group achieved freedom from AF recurrence, compared to 64% (EGM) and 54% (ANAT).
- The EXT group demonstrated significantly lower AF/atrial tachycardia recurrence rates.
- AF termination occurred most frequently in the EXT group (66.7%) and was linked to reduced recurrence.
Conclusions:
- Extensive electro-anatomical guided ablation offers superior outcomes for PerAF compared to other tested strategies.
- Achieving AF termination during ablation is a reliable indicator of successful long-term outcomes.
Aims:
The optimal strategy for persistent atrial fibrillation (PerAF) is poorly defined. We conducted a multicentre, randomized, prospective trial to compare the outcomes of different ablation strategies for PerAF.
Methods And Results:
We enrolled 450 patients and randomly assigned them in a 1:1:1 ratio to undergo pulmonary vein isolation and subsequently undergo the following three different ablation strategies: anatomical guided ablation (ANAT group, n = 150), electrogram guided ablation (EGM group, n = 150), and extensive electro-anatomical guided ablation (EXT group, n = 150). The primary endpoint was freedom from atrial fibrillation (AF) lasting longer than 30 s at 12 months after a single ablation procedure. After 12 months of follow-up, 72% (108) of patients in the EXT group were free from AF recurrence, as compared with the 64% (96) in the EGM group (P = 0.116), and 54% (81) in the ANAT group (P = 0.002). The EXT group showed less AF/atrial tachycardia recurrence than the EGM group (60% vs. 50%, P = 0.064) and the ANAT group (60% vs. 37.3%, P < 0.001). The EXT group showed the highest rate of AF termination (66.7%), followed by 56.7% in the EGM group, and 20.7% in the ANAT group. The AF termination signified less AF recurrence at 12 months compared to patients without AF termination (30.1% vs. 42.7%, P = 0.008). Safety endpoints did not differ significantly between the three groups (P = 0.924).
Conclusions:
Electro-anatomical guided ablation achieved the most favourable outcomes among the three ablation strategies. The AF termination is a reliable ablation endpoint.
