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

Yoshihide Takahashi1,2, Atsushi Kobori3, Kenichi Hiroshima4

  • 1Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences (Y.T., M.G., T.S.).

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|July 25, 2024
PubMed
Summary

Adding focal ablation to pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) did not improve outcomes. This study found PVI alone was as effective as the combined approach for long-term AF freedom.

Keywords:
atrial fibrillationcatheter ablationclinical trials, randomizedhumanspulmonary veins

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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.