Arrhythmias & electrophysiology
The Role of Posterior Wall Isolation in Catheter Ablation for Persistent Atrial Fibrillation and Systolic Heart Failure: A Secondary Analysis of a Randomized Clinical Trial
Authors' conclusion
The results of this study indicate that addition of PWI to PVI did not improve freedom from arrhythmia recurrence or recovery of LVEF in patients with persistent AF and symptomatic HFrEF. Catheter ablation was associated with significant improvements in systolic function, irrespective of ablation strategy used.
Study context
- Population
- Patients with persistent atrial fibrillation (AF) and symptomatic heart failure with reduced ejection fraction (HFrEF) (left ventricular ejection fraction (LVEF) <50% and NYHA class ≥II) from the CAPLA trial
- Participants
- 98 patients
- Comparison
- Pulmonary vein isolation (PVI) plus posterior wall isolation (PWI) vs PVI alone
- Primary endpoint
- Freedom from any documented atrial arrhythmia >30 seconds after a single ablation procedure without AAD therapy
- Follow-up
- 12 months
Methodological detailsad hoc secondary analysis, multicentre, prospective, 11 centres in 3 countries
- Ad hoc secondary analysis
- Multicentre
- Prospective
- 11 centres in 3 countries
Primary result
As reported in the abstract
Freedom from atrial arrhythmia without AAD therapy
Hazard ratio
1.02
95% CI 0.54–1.91
P = 0.96
By group
PVI plus PWI vs PVI alone
HR 1.02 (95% CI 0.54–1.91); P = 0.96
Further findings
Freedom from atrial arrhythmia with or without AAD therapy after multiple procedures
P = 0.73
Normalization of LV function
P = 0.13
| Outcome | PVI plus PWI | PVI alone | P value |
|---|---|---|---|
| AF burden | median 0 % | median 0 % | P = 0.78 |
| Change in LVEF · no difference between groups | mean change 19.3 (SD 13.0) % | mean change 18.2 (SD 14.1) % | P = 0.71 |
- Change in LVEF: within-group improvement P < .01 in both groups
Original publication
The Role of Posterior Wall Isolation in Catheter Ablation for Persistent Atrial Fibrillation and Systolic Heart Failure: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. Published 1 November 2023. doi:10.
Summarised from the published abstract; every number is checked against it