Pulmonary Veins Ablation Alone Sufficient for Persistent AF

Catheter ablation of the pulmonary veins alone can improve outcomes in around half of those suffering from persistent atrial fibrillation (AF), according to a new study.

Researchers at Southlake Regional Health Center (Newmarket, Canada), the German Heart Center (Munich, Germany), and other institutions participating in the STAR AF 2 study randomized 589 patients (median age 58, 22% women) to pulmonary vein isolation (PVI, 64 patients) alone, PVI plus ablation by complex fractionated electrogram (PVI-CFE, 254 patients), or PVI plus empiric linear ablation of lesions in the left atrium (PVI-lines, 250 patients).


The results showed that successful PVI was achieved in 97% of all patients with no differences between groups. However, procedural time was significantly shorter for the PVI alone group (167 minutes) compared to the PVA-CFE (229 minutes) and PVI plus lines (223 minutes) groups. The study also found that patients did not benefit from further ablation, since it increased treatment time and did not reduce AF recurrence. The study was presented at the European Society of Cardiology (ESC) congress, held during August-September 2014 in Barcelona (Spain).

“Among patients with persistent atrial fibrillation, freedom from recurrent atrial fibrillation was achieved in 59% of participants with PVI alone. Additional CFE or lines ablation added to procedure/fluoroscopy time, without improving freedom from atrial fibrillation,” said lead author and study presenter Atul Verma. “The results may ‘force’ a change in guideline thinking and a shift in practice to shorter and more effective pulmonary vein ablation without the addition of other ablation.”

PVI is a catheter ablation technique developed to prevent focal triggers in the pulmonary veins from initiating episodes of AF. Although the procedure initially involved ablation with a catheter directly in the pulmonary veins, isolating the pulmonary veins by applying ablation energy at their junction with the left atrium is more effective. The PVI procedure is most suitable for patients whose recurring symptomatic episodes of AF have not been suppressed by antiarrhythmic drugs, or who do not wish to take long-term antiarrhythmic or anticoagulation medications.

Related Links:
Southlake Regional Health Center
German Heart Center