Electrogram-guided pulsed field ablation for persistent atrial fibrillation: A prospective cohort study.
Kaige Li, Luigi Di Biase, Mu Qin et al.
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In 30 seconds
This single-center, prospective, nonrandomized comparative cohort study evaluated electrogram-guided pulsed field ablation (PFA) in 85 patients with persistent atrial fibrillation, compared with an anatomic pulmonary vein isolation plus posterior wall isolation strategy in another 85 patients. Electrogram-guided ablation included pulmonary vein and posterior wall isolation plus targeted electrogram ablation. At 12 months after one procedure and off antiarrhythmic drugs, freedom from atrial fibrillation or atrial tachycardia recurrence was 82.4% (70 of 85) versus 65.9% (56 of 85), respectively (log-rank P = .017). One PFA-related adverse event, hemolysis, occurred in the electrogram-guided group.
Key findings
- Intraprocedural atrial fibrillation termination occurred in 72 patients (84.7%) with electrogram-guided ablation versus 10 of 85 (11.8%) in the control group (P < .001).
- At 12 months, freedom from atrial fibrillation or atrial tachycardia was 82.4% (70 of 85) versus 65.9% (56 of 85) (log-rank P = .017; hazard ratio .47; 95% confidence interval 0.25-0.87).
- Freedom from atrial fibrillation or atrial tachycardia was 84.1% among patients with procedural atrial fibrillation termination versus 64.8% among those without it (log-rank P = .007).
- One patient (1.2%) in the electrogram-guided group had hemolysis; no other PFA-related adverse events were observed.
Why it matters
Persistent atrial fibrillation ablation strategies remain under investigation. These findings suggest that adding targeted electrogram ablation to pulmonary vein and posterior wall isolation may improve arrhythmia-free outcomes compared with an anatomic approach in this cohort. The results also highlight procedural atrial fibrillation termination as a potential marker of subsequent outcome, while requiring confirmation in stronger comparative studies.
What to keep in mind
The study was single-center and nonrandomized, so differences between groups may reflect factors beyond ablation strategy. Follow-up was reported at 12 months.