Arrhythmias & electrophysiology
Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation
Authors' conclusion
Electro-anatomical guided ablation achieved the most favourable outcomes among the three ablation strategies. The AF termination is a reliable ablation endpoint.
Study context
- Population
- Patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation
- Participants
- 450 patients
- Comparison
- Three substrate ablation strategies after pulmonary vein isolation: extensive electro-anatomical vs electrogram guided vs anatomical guided ablation
- ANATn = 150
- EGMn = 150
- EXTn = 150
- Primary endpoint
- Freedom from AF lasting >30 s after a single ablation procedure
- Follow-up
- 12 months
Methodological detailsmulticentre, prospective, 1:1:1 randomisation
- Multicentre
- Prospective
- 1:1:1 randomisation
Primary result
As reported in the abstract
Freedom from AF recurrence
EXT vs EGM: P = 0.116 · EXT vs ANAT: P = 0.002
Further findings
AF termination during ablation
| Outcome | ANAT | EGM | EXT | P value |
|---|---|---|---|---|
| AF/atrial tachycardia recurrence (EXT showed less)EXT vs EGM | — not stated in the abstract | 50% | 60% | P = 0.064 |
| AF/atrial tachycardia recurrence (EXT showed less)EXT vs ANAT | 37.3% | — not stated in the abstract | 60% | P < 0.001 |
— not stated in the abstract
AF recurrence at 12 months, with vs without AF termination
- Less AF recurrence with AF termination vs without (30.1% vs. 42.7%)
- P = 0.008
Safety
Safety endpoints
- No significant difference between the three groups
- P = 0.924
Original publication
Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation. Europace. Published 13 April 2023. doi:10.
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