Electro-Anatomical Guided Ablation Yields Best Outcomes for AF Termination

China: Atrial fibrillation (AF) is a common cardiac arrhythmia affecting millions worldwide. A recent clinical trial has suggested that AF termination is a reliable ablation endpoint for Electro-anatomical guided ablation and is published in the EP Europace Journal.

Persistent AF, which refers to AF lasting longer than 7 days, poses significant challenges in terms of management and treatment. In a recent trial, researchers aimed to compare different ablation strategies for persistent atrial fibrillation (PerAF) to determine the optimal approach for better outcomes.

The multicentre, randomized, prospective study enrolled 450 patients, randomly assigned them in a 1:1:1 ratio to undergo pulmonary vein isolation and subsequently undergo one of three different ablation strategies: anatomically guided ablation (ANAT), electrogram guided ablation (EGM), and extensive electro-anatomical guided ablation (EXT).

The trial found the following clinical takeaways:

1. After 12 months of follow-up, the EXT group showed the most favorable outcomes, with 72% (108) of patients being free from AF recurrence, compared to 64% (96) in the EGM group and 54% (81) in the ANAT group.
2. The EXT group also had less AF/atrial tachycardia recurrence compared to the EGM group (60% vs. 50%) and the ANAT group (60% vs. 37.3%).
3. The EXT group had the highest rate of AF termination at 66.7%, followed by 56.7% in the EGM group, and 20.7% in the ANAT group. AF termination was associated with less AF recurrence at 12 months compared to patients without AF termination (30.1% vs. 42.7%).
4. Safety endpoints did not differ significantly between the three groups.

The researchers concluded that electro-anatomical guided ablation (EXT) achieved the most favorable outcomes among the three ablation strategies for persistent atrial fibrillation. The study highlights the importance of AF termination as a reliable endpoint for ablation procedures and provides valuable insights for clinicians in choosing the optimal strategy for managing persistent AF.

"Our findings suggest that electro-anatomical guided ablation may be the preferred strategy for treating patients with persistent atrial fibrillation. This could potentially lead to improved outcomes and better quality of life for patients suffering from this challenging arrhythmia." said the lead author of the study, Dr. Kaige Lee.

Reference:

Li K., Xu C., Zhu X., Wang X., et al.; Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation, EP Europace, 2023; euad090, https://doi.org/10.1093/europace/euad090