PVI-Only is Not Enough for All Persistent AF Patients: A FLOW-AF Subgroup Analysis

Verma Atul

Castellano Steven

Kong Melissa H.

Neuzil Petr

Szili-Török Tamás

Spitzer Stefan G.

Rillig Andreas

Reddy Vivek Y.

2024

03.02. Klinikai orvostan

Since the STAR-AF II trial, there has been a trend toward pulmonary vein isolation (PVI)-only ablation strategies for persistent atrial fibrillation (PeAF). Electrographic Flow (EGF) mapping can identify active sources of AF and estimate the electrographic flow consistency (EGFC) of wavefront propagation through substrate, revealing functional AF mechanisms.Examine the success of a PVI-only ablation strategy for a redo PeAF/long-standing PeAF population.FLOW-AF (NCT04473963) prospectively enrolled non-paroxysmal AF patients undergoing redo ablation at 4 centers. One-minute EGF recordings using 64-pole basket catheters were obtained both pre-PVI and post-PVI following a 20-minute wait and confirmation of electrical isolation of veins. Patients with EGF-identified sources were randomized 1:1 to EGF-guided source ablation v. PVI-only. Patients with no sources were not randomized and mostly received PVI-only.Study of 85 patients enrolled: 24 with EGF-identified sources randomized to PVI-only and 23 with no sources receiving PVI-only. Of these 47 patients, those with sources (Group 2) had different clinical characteristics including older age and higher CHA2DS2-VASc compared with those with sources (Group 1). After PVI-only, Group 1 had 70% (16/23) freedom from recurrent AF (FFAF) within one year v. Group 2 with 35% (8/23), p=0.018. Additionally, patients with high electrographic flow consistency (EGFC) indicative of healthy or normal substrate had 67% (10/15) FFAF v. 45% (14/31) in those with low EGFC suggestive of abnormal substrate, p=0.011.Success rate in no sources patients receiving PVI-only is better than in those with sources randomized to PVI-only. For the clinically heterogenous population of PeAF patients, the presence of EGF-identified sources matters clinically, and PVI-only will not be enough for all patients.

angol

Folyóiratcikk

PeerReviewed

text

http://publicatio.bibl.u-szeged.hu/34983/1/Verma.pdf

Verma Atul; Castellano Steven; Kong Melissa H.; Neuzil Petr; Szili-Török Tamás; Spitzer Stefan G.; Rillig Andreas; Reddy Vivek Y.: PVI-Only is Not Enough for All Persistent AF Patients: A FLOW-AF Subgroup Analysis. HEART RHYTHM. ISSN 1547-5271 (2024) (Nyomdában)

doi:10.1016/j.hrthm.2024.10.037

http://publicatio.bibl.u-szeged.hu/34983/

https://doi.org/10.1016/j.hrthm.2024.10.037

35478264

info:eu-repo/semantics/altIdentifier/doi/10.1016/j.hrthm.2024.10.037

info:eu-repo/semantics/openAccess