ALID score for treatment-effect heterogeneity of adjunctive low-voltage area ablation in persistent atrial fibrillation: A post hoc analysis of SUPPRESS-AF.
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Egami Yasuyuki, Matsubara Haya, Muroya Ryo, Nagai Kazushi, Mukai Taichi, Sugino Ayako, Kobayashi Noriyuki, Abe Masaru, Nohara Hiroaki, Kawanami Shodai, Yasumoto Koji, Okamoto Naotaka, Matsunaga-Lee Yasuharu, Yano Masamichi, Nishino Masami, Masuda Masaharu, Tanaka Nobuaki, Watanabe Tetsuya, Minamiguchi Hitoshi, Oka Takafumi, Minamisaka Tomoko, Kanda Takashi, Okada Masato, Kawasaki Masato, Matsuda Yasuhiro, Tanaka Koji, Makino Nobuhiko, Inoue Koichi, Kida Hirota, Dohi Tomoharu, Hikoso Shungo, Sunaga Akihiro, Sotomi Yohei, Sakata Yasushi, OCVC-SUPPRESS-AF Investigators
Аннотация
OBJECTIVE: To examine whether a simple clinical score characterizes treatment-effect heterogeneity of adjunctive LVA ablation among patients with mapped LVA > 5 cm2 and to perform an exploratory supportive analysis in an independent randomized cohort.
METHODS: In this post-hoc analysis of SUPPRESS-AF, which included patients with persistent AF and mapped LVA > 5 cm2 after PVI, four variables-age ≥ 75 years, left atrial diameter > 44 mm, estimated glomerular filtration rate < 60 mL/min/1.73 m2, and absence of diabetes-were combined into the ALID score (0-4). Patients were stratified into low (0-1), intermediate (2), and high (3-4) score groups. Because EARNEST-PVI did not use LVA-guided ablation or select patients based on mapped LVA, it was analyzed as an exploratory supportive cohort rather than as an external validation cohort.
RESULTS: In SUPPRESS-AF (n = 336), a significant treatment-by-score interaction was observed (P < 0.001). Adjunctive LVA ablation was associated with increased recurrence in the low-score stratum (HR 3.92; 95% CI 1.50-10.20) and reduced recurrence in the high-score stratum (HR 0.48; 95% CI 0.26-0.86). In EARNEST-PVI (n = 494), a qualitatively similar interaction pattern was observed for additional ablation beyond PVI (interaction P = 0.029), although the ablation strategy differed from LVA-guided ablation.
CONCLUSIONS: Among patients with persistent AF and mapped LVA >5 cm2, the ALID score identified heterogeneity in response to adjunctive LVA ablation. These hypothesis-generating findings require prospective validation before clinical implementation.