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Related Experiment Video

Updated: Mar 6, 2026

Robotic Ablation of Atrial Fibrillation
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Are Genetics Useful to Guide Ablation Strategies in Patients With Persistent Atrial Fibrillation?

Michael W Lim1,2,3,4, Peter M Kistler2,3,4, Annie G Curtin2,4

  • 1Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.

Journal of Cardiovascular Electrophysiology
|March 4, 2026
PubMed
Summary

Adding posterior wall isolation (PWI) to pulmonary vein isolation (PVI) did not improve ablation outcomes for persistent atrial fibrillation (AF) patients with high AF polygenic risk scores (PRS). These findings suggest PVI alone is sufficient for this patient group.

Keywords:
persistent atrial fibrillationpolygenic risk scoreposterior wall isolation

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Area of Science:

  • Cardiology
  • Genetics
  • Electrophysiology

Background:

  • Persistent atrial fibrillation (AF) ablation outcomes vary.
  • High AF polygenic risk scores (PRS) correlate with increased left atrial substrate and recurrence.
  • The benefit of extensive ablation (PVI with PWI) in high AF-PRS patients remains unclear.

Purpose of the Study:

  • To assess if adjunctive posterior wall isolation (PWI) improves ablation outcomes in persistent AF patients stratified by AF polygenic risk score (PRS).

Main Methods:

  • Genome-wide genotyping was used to derive an AF-PRS in a CAPLA trial subgroup.
  • The primary endpoint was freedom from atrial arrhythmia at 3 years post-ablation.
  • Patients with high AF-PRS underwent either PVI with PWI or PVI alone.

Main Results:

  • 174 patients (75.29% male, median age 66.70) were evaluated with significantly higher mean AF-PRS than controls.
  • In high AF-PRS patients, PVI with PWI (n=36) showed no significant difference versus PVI alone (n=49) in arrhythmia-free survival (p=0.883).
  • No significant differences were observed in arrhythmia burden (p=0.772) or quality of life (p=0.794) between groups.

Conclusions:

  • In persistent AF patients with high AF-PRS, adding PWI to PVI did not significantly enhance long-term ablation success.
  • Pulmonary vein isolation alone may be sufficient for these high-risk patients.