Arrhythmias & electrophysiologyRandomised controlled trial
Clinical Implications of Adjunctive Posterior Wall Isolation According to Ablation Modality: A Subanalysis of the CORNERSTONE AF Trial
- randomized trial subanalysis
- randomization stratified by pulmonary vein isolation (PVI) ablation modality
Authors' conclusion
Adjunctive LAPWI did not significantly improve freedom from atrial arrhythmia with either ablation modality, with no significant treatment-by-modality interaction. The potentially favorable findings with LAPWI after cryoballoon PVI should be considered exploratory and hypothesis-generating.
Study context
- Population
- Patients undergoing ablation for persistent or longstanding persistent atrial fibrillationPVI alone n=259, PVI+left atrial posterior wall isolation (LAPWI) n=254 · radiofrequency 384 · cryoballoon 129
- Participants
- 259 vs 254
- Comparison
- PVI alone vs PVI+LAPWI, according to PVI ablation modality
- PVI alonen = 259
- PVI+LAPWIn = 254
- Primary endpoint
- Freedom from atrial arrhythmia
- Follow-up
- 18 months
Primary result
As reported in the abstract
- LAPWI vs PVI alone: 82.0% vs. 69.1%; P = 0.163
- LAPWI vs PVI alone: 80.5% vs. 79.4%; P = 0.309
- P for interaction=0.64
Secondary outcomes
| Outcome | Estimate | P value |
|---|---|---|
| Freedom from repeat ablation — LAPWI vs PVI alone · cryoballoon subgroup | 96.5% vs. 82.0% | P = 0.029 |
| Freedom from repeat ablation — LAPWI vs PVI alone · radiofrequency subgroup | 90.1% vs. 88.5% | P = 0.210 |
- Freedom from repeat ablation: P for interaction=0.17
LAPWI area
- LAPWI area significantly larger in the cryoballoon than in the radiofrequency subgroup
Procedure and fluoroscopy time
- Additional LAPWI significantly prolonged procedure time without increasing fluoroscopy time in both subgroups
Safety
Complications
- symptomatic gastroparesis in the radiofrequency LAPWI subgroup
- three patients
- Overall complication rates were similar between groups
Original publication
Clinical Implications of Adjunctive Posterior Wall Isolation According to Ablation Modality: A Subanalysis of the CORNERSTONE AF Trial. Heart Rhythm. Published 24 September 2026. doi:10.1016/j.hrthm.2026.09.031
Summarised from the published abstract; every number is checked against it