Arrhythmias & electrophysiology
Posterior Wall Isolation Improves Outcomes for Persistent Atrial Fibrillation (AF) With Rapid Posterior Wall Activity: CAPLA Substudy
Corrected 23 Oct 2026: Measure wording clarified; no values changed.
Authors' conclusion
Rapid PW activity is associated with an increased risk of AF recurrence post-catheter ablation. The addition of PWI in this subgroup was associated with a significant improvement in freedom from AF compared with PVI alone.
Study context
- Population
- Patients with persistent AF in spontaneous AF at the time of ablation in the CAPLA trialrandomised 50%/50%
- Participants
- 151 patients
- Comparison
- Pulmonary vein isolation (PVI)+PWI vs PVI alone, by pulmonary vein (PV) and posterior wall (PW) electrical characteristics
- Primary endpoint
- Freedom from AF off antiarrhythmic drug therapy (AF recurrence)
- Follow-up
- 12 months
Methodological detailssubgroup analysis
- Subgroup analysis
Primary result
As reported in the abstract
Arrhythmia-free survival with rapid PW activity (shortest PW cycle length <140 ms)
Hazard ratio (95% CI)P value
Rapid PW activityvs Slower PW activityAF recurrence, PVI only: 55.3% vs 46.5%
1.50(1.11–2.26)
log-rank P = 0.036- PVI+PWI vs PVI · rapid PW activity subgroup
- HR 0.78 (95% CI 0.67–0.94), event not clearly stated; log-rank P = 0.030
- Rapid PV activity and PV cycle length not associated with outcome regardless of ablation strategy
- all P > 0.05
Further findings
AF recurrence by PW activity, PVI-only patients · 12 months
Arrhythmia-free survival with addition of PWI, by subgroup
- Addition of PWI, left atrial (LA) enlargement (LA volume index >34 mL/m²): no improvement, HR
- 0.69 (95% CI 0.39-1.25; P = 0.301)
- Addition of PWI, posterior low-voltage zone: no improvement, HR
- 1.06 (95% CI 0.68-1.66; P = 0.807)
- Addition of PWI, long-standing persistent atrial fibrillation (PerAF): no improvement, HR
- 1.10 (95% CI 0.71-1.72; P = 0.669)
Rapid PV activity and PV cycle length
- Not associated with outcome regardless of ablation strategy
- all P > 0.05
Correlation of PW cycle length with posterior low voltage
- No correlation, r
- −0.06
- P
- P = 0.496
Original publication
Posterior Wall Isolation Improves Outcomes for Persistent AF With Rapid Posterior Wall Activity: CAPLA Substudy. JACC Clin Electrophysiol. Published 25 August 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →