Comparison of Spatio-Temporal Dispersion Electrogram Ablation and Low Voltage Zone Ablation in Patients With...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Pulmonary vein isolation (PVI) alone is less effective for persistent atrial fibrillation (AF) than paroxysmal AF.
• Spatio-temporal dispersion electrogram (STDE) ablation shows promise as an adjunct to PVI.
• Direct comparisons between STDE and low-voltage zone (LVZ) ablation efficacy are limited.

Purpose of the Study:

• To compare the efficacy of STDE-guided ablation versus LVZ ablation as additional treatments post-PVI for persistent AF.
• To evaluate the long-term recurrence rates of atrial arrhythmias between the two ablation strategies.

Main Methods:

• Retrospective observational study of 107 patients with persistent AF undergoing catheter ablation.
• STDE ablation group (n=53) received STDE evaluation and guided substrate modification.
• Control group (n=54) received additional ablation based on LVZ without STDE evaluation.
• Primary endpoint: atrial arrhythmia recurrence up to 24 months post-ablation, with a 3-month blanking period.

Main Results:

• The STDE group underwent significantly more additional ablation procedures.
• AF-free survival at 24 months was significantly higher in the STDE group (76.3%) compared to the LVZ group (58.4%; p=0.027).
• STDE ablation was independently associated with a lower risk of AF recurrence (HR: 0.29; p=0.004), while prolonged AF duration and larger left atrial size predicted recurrence.

Conclusions:

• STDE-guided ablation is more effective in reducing AF recurrence compared to PVI with LVZ ablation.
• STDE ablation represents a superior strategy for substrate modification in persistent AF patients.
• Further prospective studies are warranted to confirm these findings.