Circulation journal : official journal of the Japanese Circulation Society · 2026
Concomitant Diabetes Mellitus Diminishes the Efficacy of Left Atrial Additional Ablation Following Pulmonary Vein Isolation - A Subanalysis of the EARNEST-PVI Trial.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Matsuda Yasuhiro, Masuda Masaharu, Tanaka Nobuaki, Watanabe Tetsuya, Minamiguchi Hitoshi, Egami Yasuyuki, Oka Takafumi, Miyoshi Miwa, Okada Masato, Kawasaki Masato, Mano Toshiaki, Tsujimura Takuya, Uematsu Hiroyuki, Ooka Hirotaka, Kudo Satoshi, Okamoto Shin, Ishihara Takayuki, Nanto Kiyonori, Hata Yosuke, Nakao Sho, Kusuda Masaya, Ariyasu Wataru, Inoue Koichi, Hikoso Shungo, Sunaga Akihiro, Dohi Tomoharu, Okada Katsuki, Nakatani Daisaku, Sotomi Yohei, Sakata Yasushi, Osaka Cardiovascular Conference (OCVC)-Arrhythmia Investigators
Аннотация
BACKGROUND: The EARNEST-PVI trial showed that left atrial ablation in addition to pulmonary vein isolation (PVI) reduced atrial fibrillation (AF) recurrence after catheter ablation for persistent AF; however, the efficacy of left atrial additional ablation in patients with diabetes mellitus (DM) is not well known. The aim of this study was to evaluate the efficacy of left atrial additional ablation after PVI in patients with and without DM.
METHODS AND RESULTS: This study, a subanalysis of the EARNEST-PVI trial, a multicenter, prospective, randomized, controlled trial, analyzed 493 consecutive patients undergoing initial radiofrequency catheter ablation for persistent AF. Patients were randomized to PVI alone (PVI-alone group) or PVI plus linear and/or complex fractionated atrial electrogram ablation (PVI-plus group). The primary outcome was defined as AF recurrence during the 12-month follow-up period after ablation. A total of 84 (17%) patients had DM. The primary outcome occurred in 120 (24%) patients. In patients without DM, freedom from AF recurrence was significantly higher in the PVI-plus group than in the PVI-alone group (80.0% vs. 71.1%, P=0.034). In contrast, in patients with DM, freedom from AF recurrence was similar between the PVI-plus and PVI-alone groups (75.4% vs. 72.9%, P=0.696).
CONCLUSIONS: The efficacy of left atrial additional ablation after PVI in reducing AF recurrence following catheter ablation for persistent AF was diminished in patients with DM.
METHODS AND RESULTS: This study, a subanalysis of the EARNEST-PVI trial, a multicenter, prospective, randomized, controlled trial, analyzed 493 consecutive patients undergoing initial radiofrequency catheter ablation for persistent AF. Patients were randomized to PVI alone (PVI-alone group) or PVI plus linear and/or complex fractionated atrial electrogram ablation (PVI-plus group). The primary outcome was defined as AF recurrence during the 12-month follow-up period after ablation. A total of 84 (17%) patients had DM. The primary outcome occurred in 120 (24%) patients. In patients without DM, freedom from AF recurrence was significantly higher in the PVI-plus group than in the PVI-alone group (80.0% vs. 71.1%, P=0.034). In contrast, in patients with DM, freedom from AF recurrence was similar between the PVI-plus and PVI-alone groups (75.4% vs. 72.9%, P=0.696).
CONCLUSIONS: The efficacy of left atrial additional ablation after PVI in reducing AF recurrence following catheter ablation for persistent AF was diminished in patients with DM.