Pulmonary vein isolation with myocardium ablation improves AF outcomes: NEJM

Written By : Jacinthlyn Sylvia |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-10-31T09:00:54+05:30 | Updated On 31 Oct 2022 11:38 AM IST

Results in patients with persistent atrial fibrillation (AF) were dramatically improved by pulmonary vein isolation (PVI) combined with customized ablation of atrial low-voltage myocardium, says an article published in The New England Journal of Medicine.

There is ongoing discussion over clinically viable ablation techniques for patients with persistent atrial fibrillation. In randomized controlled clinical trials, ablation targets and methods other than pulmonary vein isolation have not yet demonstrated a consistent improvement in outcome. In order to enhance rhythm regulation in patients with persistent AF, Yan Huo and team report a controlled trial comparing ablation of atrial low-voltage myocardium combined with PVI to PVI alone.

To find out whether PVI combined with customized substrate ablation of atrial low-voltage myocardium improves outcomes in patients with persistent AF, researchers undertook a multicenter, randomized experiment. They distributed PVI alone to 163 patients (163 patients; PVI only) or PVI with substrate modification to 161 patients (161 patients; PVI+SM) at random among 324 individuals. Using serial 7-day ECG recordings during 12 months of surveillance, the primary study end goal was the first occurrence of an atrial arrhythmia lasting more than 30 seconds following a single ablation, with 3 months blanking. Implantable heart monitors were also advised for patients.

The key findings of this study were:

1. In 75 PVI-only patients (50%) and 54 PVI+SM patients (35%), the primary study end goal was reached.

2. Three PVI-only patients (1.8%) and six PVI+SM patients (3.7%) experienced negative outcomes. In 242 individuals, implant monitoring was employed.

3. Recurrences occurred in 65 PVI-only patients (55%) versus 47 PVI+SM patients (39%) among them.

In conclusion, In the ERASE-AF trial, it was discovered that PVI+SM was more effective than pulmonary vein isolation (PVI) alone at treating patients with persistent atrial fibrillation and preventing recurrent atrial arrhythmias.

Reference:

Huo, Y., Gaspar, T., Schönbauer, R., Wójcik, M., Fiedler, L., Roithinger, F. X., Martinek, M., Pürerfellner, H., Kirstein, B., Richter, U., Ulbrich, S., Mayer, J., Zedda, A., Piorkowski, J., & Piorkowski, C. (2022). Low-Voltage Myocardium-Guided Ablation Trial of Persistent Atrial Fibrillation. In NEJM Evidence (Vol. 1, Issue 11). Massachusetts Medical Society. https://doi.org/10.1056/evidoa2200141

atrial fibrillationPulmonary vein isolationThe New England Journal of Medicine

Source : The New England Journal of Medicine

Jacinthlyn Sylvia

Neuroscience Masters graduate

Jacinthlyn Sylvia, a Neuroscience Master's graduate from Chennai has worked extensively in deciphering the neurobiology of cognition and motor control in aging. She also has spread-out exposure to Neurosurgery from her Bachelor’s. She is currently involved in active Neuro-Oncology research. She is an upcoming neuroscientist with a fiery passion for writing. Her news cover at Medical Dialogues feature recent discoveries and updates from the healthcare and biomedical research fields. She can be reached at editorial@medicaldialogues.in

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751