Long-Term Impact of Additional Ablation After Pulmonary Vein Isolation : Results From EARNEST-PVI Trial
Background An optimal strategy for left atrial ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not been determined. Methods and Results We conducted an extended follow-up of the multicenter randomized controlled EARNEST-PVI (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) trial, which compared 12-month rhythm outcomes in patients with persistent AF between patients randomized to a PVI-alone strategy (n=248) or PVI-plus strategy (n=248; PVI followed by left atrial additional ablation, including linear ablation or ablation targeting areas with complex fractionated electrograms). The present study extended the follow-up period to 3 years after enrollment. Outcomes were compared not only between randomly allocated groups but also between on-treatment groups categorized by actually created ablation lesions. Recurrence rate of AF or atrial tachycardia (AT) was lower in the randomly allocated to PVI-plus group than the PVI-alone group (29.0% versus 37.5%, P=0.036). On-treatment analysis revealed that patients with PVI+linear ablation (n=205) demonstrated a lower AF/AT recurrence rate than those with PVI only (26.3% versus 37.8%, P=0.007). In contrast, patients with PVI+complex fractionated electrograms ablation (n=37) had an AF/AT recurrence rate comparable to that of patients with PVI only (40.5% versus 37.8%, P=0.76). At second ablation in 126 patients with AF/AT recurrence, ATs excluding common atrial flutter were more frequent in patients with PVI+linear ablation than in those with PVI only (32.6% versus 5.7%, P<0.0001). Conclusions Left atrial ablation in addition to PVI was efficacious during 3-year follow-up. Linear ablation was superior to other ablation strategies but may increase iatrogenic ATs. Registration URL: http://www.umin.ac.jp/ctr/index-j.htm; Unique identifier: UMIN000019449.
| Errataetall: |
CommentIn: J Am Heart Assoc. 2023 Sep 5;12(17):e031258. - PMID 37642025 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Journal of the American Heart Association - 12(2023), 17 vom: 05. Sept., Seite e029651 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Masuda, Masaharu [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 06.09.2023 Date Revised 05.10.2023 published: Print-Electronic UMIN-CTR: UMIN000019449 CommentIn: J Am Heart Assoc. 2023 Sep 5;12(17):e031258. - PMID 37642025 Citation Status MEDLINE |
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| doi: |
10.1161/JAHA.123.029651 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM361400055 |
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| 100 | 1 | |a Masuda, Masaharu |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Long-Term Impact of Additional Ablation After Pulmonary Vein Isolation |b Results From EARNEST-PVI Trial |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 05.10.2023 | ||
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| 500 | |a CommentIn: J Am Heart Assoc. 2023 Sep 5;12(17):e031258. - PMID 37642025 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Background An optimal strategy for left atrial ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not been determined. Methods and Results We conducted an extended follow-up of the multicenter randomized controlled EARNEST-PVI (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) trial, which compared 12-month rhythm outcomes in patients with persistent AF between patients randomized to a PVI-alone strategy (n=248) or PVI-plus strategy (n=248; PVI followed by left atrial additional ablation, including linear ablation or ablation targeting areas with complex fractionated electrograms). The present study extended the follow-up period to 3 years after enrollment. Outcomes were compared not only between randomly allocated groups but also between on-treatment groups categorized by actually created ablation lesions. Recurrence rate of AF or atrial tachycardia (AT) was lower in the randomly allocated to PVI-plus group than the PVI-alone group (29.0% versus 37.5%, P=0.036). On-treatment analysis revealed that patients with PVI+linear ablation (n=205) demonstrated a lower AF/AT recurrence rate than those with PVI only (26.3% versus 37.8%, P=0.007). In contrast, patients with PVI+complex fractionated electrograms ablation (n=37) had an AF/AT recurrence rate comparable to that of patients with PVI only (40.5% versus 37.8%, P=0.76). At second ablation in 126 patients with AF/AT recurrence, ATs excluding common atrial flutter were more frequent in patients with PVI+linear ablation than in those with PVI only (32.6% versus 5.7%, P<0.0001). Conclusions Left atrial ablation in addition to PVI was efficacious during 3-year follow-up. Linear ablation was superior to other ablation strategies but may increase iatrogenic ATs. Registration URL: http://www.umin.ac.jp/ctr/index-j.htm; Unique identifier: UMIN000019449 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a left atrial ablation | |
| 650 | 4 | |a linear ablation | |
| 650 | 4 | |a persistent atrial fibrillation | |
| 650 | 4 | |a recurrence | |
| 700 | 1 | |a Inoue, Koichi |e verfasserin |4 aut | |
| 700 | 1 | |a Tanaka, Nobuaki |e verfasserin |4 aut | |
| 700 | 1 | |a Watanabe, Tetsuya |e verfasserin |4 aut | |
| 700 | 1 | |a Makino, Nobuhiko |e verfasserin |4 aut | |
| 700 | 1 | |a Egami, Yasuyuki |e verfasserin |4 aut | |
| 700 | 1 | |a Oka, Takafumi |e verfasserin |4 aut | |
| 700 | 1 | |a Minamiguchi, Hitoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Miyoshi, Miwa |e verfasserin |4 aut | |
| 700 | 1 | |a Okada, Masato |e verfasserin |4 aut | |
| 700 | 1 | |a Kanda, Takashi |e verfasserin |4 aut | |
| 700 | 1 | |a Mano, Toshiaki |e verfasserin |4 aut | |
| 700 | 1 | |a Matsuda, Yasuhiro |e verfasserin |4 aut | |
| 700 | 1 | |a Uematsu, Hiroyuki |e verfasserin |4 aut | |
| 700 | 1 | |a Sakio, Takashige |e verfasserin |4 aut | |
| 700 | 1 | |a Kawasaki, Masato |e verfasserin |4 aut | |
| 700 | 1 | |a Sunaga, Akihiro |e verfasserin |4 aut | |
| 700 | 1 | |a Sotomi, Yohei |e verfasserin |4 aut | |
| 700 | 1 | |a Dohi, Tomoharu |e verfasserin |4 aut | |
| 700 | 1 | |a Nakatani, Daisaku |e verfasserin |4 aut | |
| 700 | 1 | |a Hikoso, Shungo |e verfasserin |4 aut | |
| 700 | 1 | |a Sakata, Yasushi |e verfasserin |4 aut | |
| 700 | 0 | |a Osaka Cardiovascular Conference (OCVC)‐Arrhythmia Investigators |e verfasserin |4 aut | |
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