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Updated: May 24, 2025
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Aggressive ablation vs. regular ablation for persistent atrial fibrillation: a multicentre real-world cohort study
Kaige Li1, Yangbin Shi1, Xinhua Wang2
1Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai Chest Hospital, No. 241 West Huaihai Road, Shanghai 200030, China.
Insights
Aggressive ablation strategies for persistent atrial fibrillation (PerAF) improve recurrence-free survival compared to regular ablation. Moderately aggressive approaches and achieving atrial fibrillation termination are key to better clinical outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Optimal ablation strategies for persistent atrial fibrillation (PerAF) require further clarification.
- Previous randomized controlled trials (RCTs) suggested favorable outcomes with aggressive ablation, but real-world data are limited.
Purpose of the Study:
- To evaluate the real-world effectiveness of aggressive versus regular catheter ablation strategies in patients with PerAF.
- To determine if achieving atrial fibrillation (AF) termination during ablation is a reliable endpoint.
Main Methods:
- A retrospective analysis of 4833 PerAF patients undergoing catheter ablation across 10 centers.
- Patients were categorized into regular ablation (PVI-only or PVI plus anatomical) and aggressive ablation (anatomical plus electrogram-guided) groups.
- Propensity score (PS) matching was used to compare outcomes, with a primary endpoint of 12-month AF/atrial tachycardia (AT) recurrence-free survival off anti-arrhythmic drugs.
Main Results:
- The aggressive ablation group demonstrated superior 12-month AF/AT-free survival (66.2% vs. 59.3%, P < 0.001) compared to the regular group.
- Procedural AF termination rates were significantly higher in the aggressive group (67.0% vs. 21.0%, P < 0.001), and achieving termination correlated with improved recurrence-free survival (72.3% vs. 55.2%, P < 0.001).
- Safety endpoints did not differ significantly; moderately aggressive ablation showed better outcomes than regular ablation, while extremely aggressive ablation showed declining trends.
Conclusions:
- Aggressive ablation strategies yield more favorable outcomes for PerAF patients compared to regular ablation.
- Moderately aggressive ablation appears to be associated with optimal clinical results.
- Atrial fibrillation termination during the procedure is a significant and reliable endpoint for successful ablation.
Aims:
Current guidelines for the optimal ablation strategy for persistent atrial fibrillation (PerAF) remain unclear. While our previous RCT confirmed the favourable prognosis of aggressive ablation, real-world evidence is still lacking.
Methods And Results:
Among 4833 PerAF patients undergoing catheter ablation at 10 centres, two groups were defined: regular ablation (PVI-only or PVI plus anatomical ablation) and aggressive ablation (anatomical plus electrogram-guided ablation), with 1560 patients each after propensity score (PS) matching. The primary endpoint was 12-month AF/atrial tachycardia (AT) recurrence-free survival off anti-arrhythmic drugs after a single procedure. Additional PS matching was performed within the regular group between PVI-only and anatomical ablation (n = 455 each). Furthermore, anatomical ablation from the regular group was independently matched with aggressive ablation (n = 1362 each). At 12 months, the aggressive group showed superior AF/AT-free survival (66.2% vs. 59.3%, P < 0.001; HR 0.745), similar AT recurrence (12.0% vs. 11.3%, P = 0.539), and significantly higher procedural AF termination (67.0% vs. 21.0%, P < 0.001) than regular group. Moreover, patients with AF termination had improved AF/AT-free survival (72.3% vs. 55.2%, P < 0.001). Safety endpoints did not differ significantly between the two groups. Both the ablation outcomes and AF termination rate showed increasing trends with the extent of ablation aggressiveness but declined with extremely aggressive ablation. After additional PS matching, within the regular group, no statistical differences were observed though AF/AT-free survival in the anatomical group was slightly higher than the PVI-only group (60.7% vs. 55.6%, P = 0.122); while aggressive ablation showed improved AF/AT-free survival compared to anatomical ablation alone from regular group (67.5% vs. 59.9%, P < 0.001).
Conclusion:
Aggressive ablation achieved more favourable outcomes than regular ablation, and moderately aggressive ablation may be associated with better clinical outcomes. AF termination is a reliable ablation endpoint.
