Mapping-Guided Ablation for Persistent Atrial Fibrillation (MAP-AF): A Multicenter, Single-Blind, Randomized...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Pulmonary vein isolation (PVI) has suboptimal outcomes for persistent atrial fibrillation (AF).
• Atrial sites outside pulmonary veins show focal activation during AF.
• Identifying and ablating these sites may improve AF treatment.

Purpose of the Study:

• To assess if adding focal activation site ablation to PVI improves clinical outcomes in persistent AF patients.
• To compare the efficacy of PVI alone versus PVI with mapping-guided focal ablation.

Main Methods:

• Multicenter, randomized, single-blinded trial involving 200 patients with persistent AF.
• Patients were randomized 1:1 to PVI alone or PVI with mapping-guided focal ablation.
• Focal sites were identified using CARTOFINDER and ablated; primary endpoint was AF freedom off antiarrhythmics after 90 days.

Main Results:

• Two-year freedom from AF/atrial tachycardia off drugs was 66.8% in the mapping-guided group and 75.2% in the PVI alone group (HR 1.26, P=0.37).
• Focal activation sites were identified at an average of 2.6 in the left atrium and 2.5 in the right atrium per patient.
• Adverse events occurred in 3.0% of the mapping-guided group versus 0% in the PVI alone group (P=0.12).

Conclusions:

• The addition of mapping-guided focal activation site ablation to PVI did not significantly improve clinical outcomes for persistent AF.
• PVI alone demonstrated comparable or superior efficacy in achieving long-term AF freedom compared to the combined approach.