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Randomized Controlled Trial
. 2023 May 19;25(5):euad090.
doi: 10.1093/europace/euad090.

Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation

Kaige Li  1 , Changhao Xu  1 , Xiyao Zhu  2 , Xinhua Wang  3 , Ping Ye  4 , Weifeng Jiang  1 , Shaohui Wu  1 , Kai Xu  1 , Xiangting Li  5 , Ying Wang  6 , Qidong Zheng  7 , Yanzhe Wang  8 , Lihua Leng  9 , Zengtang Zhang  10 , Bing Han  11 , Yu Zhang  1 , Mu Qin  1 , Xu Liu  1
Affiliations
Randomized Controlled Trial

Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation

Kaige Li et al. Europace. .

Abstract

Aims: The optimal strategy for persistent atrial fibrillation (PerAF) is poorly defined. We conducted a multicentre, randomized, prospective trial to compare the outcomes of different ablation strategies for PerAF.

Methods and results: We enrolled 450 patients and randomly assigned them in a 1:1:1 ratio to undergo pulmonary vein isolation and subsequently undergo the following three different ablation strategies: anatomical guided ablation (ANAT group, n = 150), electrogram guided ablation (EGM group, n = 150), and extensive electro-anatomical guided ablation (EXT group, n = 150). The primary endpoint was freedom from atrial fibrillation (AF) lasting longer than 30 s at 12 months after a single ablation procedure. After 12 months of follow-up, 72% (108) of patients in the EXT group were free from AF recurrence, as compared with the 64% (96) in the EGM group (P = 0.116), and 54% (81) in the ANAT group (P = 0.002). The EXT group showed less AF/atrial tachycardia recurrence than the EGM group (60% vs. 50%, P = 0.064) and the ANAT group (60% vs. 37.3%, P < 0.001). The EXT group showed the highest rate of AF termination (66.7%), followed by 56.7% in the EGM group, and 20.7% in the ANAT group. The AF termination signified less AF recurrence at 12 months compared to patients without AF termination (30.1% vs. 42.7%, P = 0.008). Safety endpoints did not differ significantly between the three groups (P = 0.924).

Conclusions: Electro-anatomical guided ablation achieved the most favourable outcomes among the three ablation strategies. The AF termination is a reliable ablation endpoint.

Keywords: Atrial fibrillation; Catheter ablation; Substrate.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
Extensive electro-anatomical guided ablation for persistent atrial fibrillation.
Figure 1
Figure 1
Study flowchart. PVI, pulmonary vein isolation; ANAT group, the anatomical guided ablation group; EGM group, the electrogram guided ablation group; EXT group, the extensive electro-anatomical guided ablation group.
Figure 2
Figure 2
Distribution of targeted EGM regions in the EGM group and the EXT group. LA, left atrium; RA, right atrium; EGM, electrogram.
Figure 3
Figure 3
Kaplan–Meier (K–M) survival curves of study outcomes among the three groups. (A) Comparison of primary outcome among the three groups. (B) Comparison of secondary outcome among the three groups. AF, atrial fibrillation; ANAT group, the anatomical guided ablation group; EGM group, the electrogram guided ablation group; EXT group, the extensive electro-anatomical guided ablation group.
Figure 4
Figure 4
Kaplan–Meier (K–M) survival curves of study outcomes between patients with and without AF termination. (A) Comparison of primary outcome between patients with and without AF termination. (B) Comparison of secondary outcome between patients with and without AF termination. AF, atrial fibrillation; AT, atrial tachycardia.
See this image and copyright information in PMC

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