Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation: IMPPROVE-PAF Trial

doi:10.1016/j.jacep.2023.01.014

Arrhythmias & electrophysiology

Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation: IMPPROVE-PAF Trial

JACC Clin ElectrophysiolPublished 22 Mar 2023Retrospective cohort study

Main findingResultHazard ratio 2.79 95% CI 1.64–4.74

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Authors' conclusion

Compared with cryoballoon PVI, cryoballoon PVI+PWI appears to be associated with greater freedom from recurrent atrial arrhythmias and AF in patients with PAF during long-term follow-up >3 years.

Study context

Population: Patients with symptomatic paroxysmal atrial fibrillation (AF) undergoing cryoballoon ablationmatched cohort
Participants: 320 patients

Exposure: Cryoballoon pulmonary vein isolation (PVI)+posterior wall isolation (PWI) vs cryoballoon PVI alone
PVI+PWIn = 160
PVIn = 160reference
Outcome: Long-term freedom from all atrial arrhythmias and from AF
Follow-up: 39 ± 9 months

Methodological details1:1 nearest-neighbor matched

1:1 nearest-neighbor matched

Main finding

As reported in the abstract

39 ± 9 months

Hazard ratio

2.79

95% CI 1.64–4.74

P < 0.001

By group

PVI+PWI

Freedom from all atrial arrhythmias: 67.5%
Freedom from AF: 75.6%

PVI

Freedom from all atrial arrhythmias: 45.0%
Freedom from AF: 55.0%

Freedom from all atrial arrhythmias

PVI+PWI67.5%

PVI45.0%

Freedom from AF

PVI+PWI75.6%

PVI55.0%

PVI+PWIvs PVI

HR 2.79 (95% CI 1.64–4.74); P < 0.001

Observational data: associations, not effects.

Further findings

Need for cardioversion and repeat catheter ablation · long-term · repeat catheter ablation

P = 0.001

Cardioversion

P = 0.02

PVI+PWI16.9%

PVI27.5%

Repeat ablation

PVI+PWI11.9%

PVI26.3%

Outcome	PVI+PWI	PVI	P value
Cryoablation and procedure times
Cryoablation time	42 ± 11 minutes	23 ± 10 minutes	P < 0.001
Procedure time	127 ± 14 minutes	103 ± 24 minutes	P < 0.001
Adjunct radiofrequency ablation required (PVI+PWI)	24.4%	— not stated in the abstract

— not stated in the abstract

Adjunct radiofrequency ablation required (PVI+PWI): 39 of 160 patients

Freedom from atrial arrhythmias and AF · 12 months

No differences at 12 months

Safety

Adverse events · similar

P = 0.31

PVI+PWI1.9%

PVI3.8%

Original publication

Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation: IMPPROVE-PAF Trial. JACC Clin Electrophysiol. Published 22 March 2023. doi:10.1016/j.jacep.2023.01.014

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