PO-02-036 THE POSTERIOR WALL ISOLATION FOR PERSISTENT ATRIAL FIBRILLATION HIGH POWER SHORT DURATION (PEF-HOT) TRIAL

Abstract

Treatment of persistent atrial fibrillation (PeF) remains a procedural challenge with high recurrence rate after catheter ablation. Posterior wall isolation (PWI) has emerged as a potential concomitant treatment strategy for PAF with conflicting outcomes. PWI introduces a left atrial (LA) roof and low posterior line through a series of radiofrequency (RF) applications to achieve entrance and exit block of the LA posterior wall. It remains unclear whether PWI with pulmonary vein isolation (PVI) during initial catheter ablation improves success rate over PVI alone. This study investigated whether PWI with PVI reduced recurrence rates compared to PVI alone in patients with PeF undergoing first-time radiofrequency ablation utilizing high-power-short-duration (HPSD) ablation. In this prospective, multicenter, randomized controlled trial, we randomized 67 patients with symptomatic PeF undergoing initial ablation to either PVI+PWI (n = 39) or PVI (n = 28) alone. The primary endpoint was freedom from atrial arrhythmias after a single procedure. Of the 67 study participants, the median duration of PeF was 0.67 (interquartile range, 0.25 - 2) years. The mean CHADS-VASc score was 2.7±1.6. No significant difference was found in the baseline characteristics between the two groups (Table 1). PWI was successfully achieved in all 39 patients in PVI+PWI group. Mean procedural times were 83.4±23.4 minutes for the PVI group, and 111.7±41.0 minutes for the PVI+PWI group. There was one complication of tamponade in the PVI+PWI group. At a median follow up of 12.4±3.0 months, the atrial arrhythmia recurrence rate did not significantly differ (P=0.9275) between PVI+PWI (20.5%) and PVI alone (21.4%). Kaplan-Meier analysis showed no significant difference in the overall AF recurrence (log-rank, P=0.9485). Additionally, the Cox univariate regression and multivariate Cox regression for all notable comorbidities revealed no significant association with procedural outcomes. In patients with PeF undergoing initial RF ablation, adjunctive PWI with PVI using HPSD did not significantly reduce recurrence rate of atrial arrhythmias.Tabled 1Table 1: Baseline Clinical CharacteristicsOverall (N = 67)Arm 1(N=28)Arm 2 (N=39)P-valueAge, mean (±SD)68.4 (±7.9)68.5 (±8.4)68.4 (±7.7)0.968Men, n (%)51 (76.1)20 (29.9)31 (46.3)0.445AF Duration, median (IQR)0.67 (0.25-2)1 (0.29-2)0.5 (0.25-2)0.440Comorbidities, n (%)Heart failure21 (31.3)10 (35.71)11 (28.21)0.513Hypertension49 (73.1)22 (78.6)27 (69.2)0.395Diabetes mellitus14 (20.9)8 (28.6)6 (15.4)0.190Stroke6 (9.0)3 (10.7)3 (7.7)0.669Vascular disease6 (9.0)2 (7.1)4 (10.3)0.660CHA2DS2-VASc score, mean (±SD)2.7 (±1.6)2.9 (±1.7)2.5 (±1.4)0.230Echocardiographic parameters, mean (±SD)LA dimension, cm4.7 (±0.6)4.6 (±0.6)4.8 (±0.6)0.206LA volume index, mL/m252.5 (±35.4)54.1 (±33.5)51.4 (±38.1)0.975LV ejection fraction, %52.1 (11.2)53.5 (±10.3)51.0 (±11.9)0.385 Open table in a new tab