Arrhythmias & electrophysiologyRandomised controlled trial
Effect of Left Atrial Size and Volume Reduction on Pulmonary Vein Isolation Efficacy in Patients With Persistent and Longstanding Persistent Atrial Fibrillation: Subset Analysis From the aMAZE Trial
- multicenter, randomized-controlled study
- subset analysis
- prespecified variables
Authors' conclusion
The correlation of LAV with PVI effectiveness in this study demonstrates that AA recurrence after PVI alone is directly related to increasing LAV. Freedom from AA after left atrial appendage ligation in addition to PVI is independent of increasing LAV, and left atrial appendage ligation may therefore provide an adjunctive benefit in patients with nonparoxysmal AF and enlarged LAV.
Study context
- Population
- Drug-refractory patients with nonparoxysmal (persistent and longstanding persistent) atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI)randomized 2:1 to LARIAT versus PVI alone · LARIAT+PVI 404 · PVI-only 206
- Participants
- 610 patients
- Comparison
- PVI-only compared with LARIAT and PVI
- LARIAT+PVIn = 404
- PVI-onlyn = 206
Primary result
As reported in the abstract
Recurrence of AA by LAV (logistic regression within each subgroup for primary effectiveness) · 12 months postprocedure
- PVI-only: recurrence of atrial arrhythmias (AA) directly related to increasing left atrial volume (LAV)
- LARIAT+PVI: freedom from recurrence of AA independent and preserved irrespective of LAV
- Similar results with LAV index
Further findings
Freedom from AA, early perAF patients in highest (>148 cm 3 ) LAV tercile · tercile analysis
- Freedom from AA, early persistent AF (perAF) patients in highest (>148 cm 3 ) LAV tercile: P =0.02
Between-group differences in early perAF cohort by LAV threshold
- Significant differences (P <0.04) began at an LAV of
- 130 cm 3
- and an LAV index of
- 65 cm 3 /m 2
Original publication
Effect of Left Atrial Size and Volume Reduction on Pulmonary Vein Isolation Efficacy in Patients With Persistent and Longstanding Persistent Atrial Fibrillation: Subset Analysis From the aMAZE Trial. Circ Arrhythm Electrophysiol. Published 28 July 2026. doi:10.1161/circep.125.014755
Summarised from the published abstract; every number is checked against it