Heart rhythm · 2026
The impact of vein of Marshall alcohol or radiofrequency ablation in patients with persistent atrial fibrillation undergoing catheter ablation in the REAL-AF registry.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Palmeri Nicholas, Neilsen Sarah, Leyton-Mange Jordan, Patel Parin, Justice Linda, Varley Allyson, Khaykin Yaariv, Sadek Mouhannad, Oza Saumil R, Hoskins Michael, D'Souza Benjamin, Jazayeri Mohammad-Ali, Bezenek Susan M, Morales Gustavo, Rajendra Anil, Berman Adam, Nair Sandeep Govindan, Silverstein Joshua, Zei Paul, Osorio Jose, Alyesh Daniel, REAL-AF Registry Investigators
Аннотация
BACKGROUND: Strategies for persistent atrial fibrillation (PsAF) ablation remain limited.
OBJECTIVE: This study aimed to determine optimal PsAF ablation strategies.
METHODS: REAL-AF (NCT04088971) is a multicenter, prospective, observational registry enrolling patients undergoing de novo ablation for atrial fibrillation. Between January 2018 and August 2024, 746 patients with PsAF were treated with radiofrequency ablation (RFA); 3 ablation methods were analyzed: group 1, pulmonary vein isolation (PVI) only; group 2, PVI + substrate modification (SM) + vein of Marshall (VoM) by RFA; and group 3, PVI + SM + VoM by ethanol (EtOH).
RESULTS: Of the overall 746 patients, 564 patients (75.6%) were treated with PVI only (group 1), 94 (12.6%) with PVI + SM + VoM RFA (group 2), and 88 (11.8%) with PVI + SM + VoM EtOH (group 3). Scar burden was higher in group 2 than groups 1 or 3 (20%, 1.0%, and 11%, respectively; P < .001). Procedure times were higher in group 3 (147 minutes; interquartile range 125.0-171.0) than groups 1 (81.0 minutes; 64.0-104.0) and 2 (90.5 minutes; 64.8-119.3). Acute complication rates were low in all groups, lowest in group 3 (0%; P = .438), and 12-month rates remained lowest in group 3 (2.3%; P = .896). Arrhythmia recurrence was reduced in group 3 through 12 months (15.3%) vs groups 1 (24.4%) and 2 (35.3%) (P = .023). Repeat ablations through 12 months trended lowest in group 3 (3.4%) vs groups 1 (5.3%) and 2 (6.4%) (P = .654).
CONCLUSION: VoM EtOH ablation for PsAF seems safe and efficacious as an adjunctive strategy for the treatment of PsAF. Findings are not based on cohort size, but on comparative effectiveness and safety across distinct ablation strategies in real-world practice.
OBJECTIVE: This study aimed to determine optimal PsAF ablation strategies.
METHODS: REAL-AF (NCT04088971) is a multicenter, prospective, observational registry enrolling patients undergoing de novo ablation for atrial fibrillation. Between January 2018 and August 2024, 746 patients with PsAF were treated with radiofrequency ablation (RFA); 3 ablation methods were analyzed: group 1, pulmonary vein isolation (PVI) only; group 2, PVI + substrate modification (SM) + vein of Marshall (VoM) by RFA; and group 3, PVI + SM + VoM by ethanol (EtOH).
RESULTS: Of the overall 746 patients, 564 patients (75.6%) were treated with PVI only (group 1), 94 (12.6%) with PVI + SM + VoM RFA (group 2), and 88 (11.8%) with PVI + SM + VoM EtOH (group 3). Scar burden was higher in group 2 than groups 1 or 3 (20%, 1.0%, and 11%, respectively; P < .001). Procedure times were higher in group 3 (147 minutes; interquartile range 125.0-171.0) than groups 1 (81.0 minutes; 64.0-104.0) and 2 (90.5 minutes; 64.8-119.3). Acute complication rates were low in all groups, lowest in group 3 (0%; P = .438), and 12-month rates remained lowest in group 3 (2.3%; P = .896). Arrhythmia recurrence was reduced in group 3 through 12 months (15.3%) vs groups 1 (24.4%) and 2 (35.3%) (P = .023). Repeat ablations through 12 months trended lowest in group 3 (3.4%) vs groups 1 (5.3%) and 2 (6.4%) (P = .654).
CONCLUSION: VoM EtOH ablation for PsAF seems safe and efficacious as an adjunctive strategy for the treatment of PsAF. Findings are not based on cohort size, but on comparative effectiveness and safety across distinct ablation strategies in real-world practice.