Novel Ablation Approach Improves Outcomes In Patients With Persistent Atrial Fibrillation

Adding integer twin-guided ablation to a modular ablation method improved outcomes successful patients pinch persistent atrial fibrillation (AF), according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 2025.

One successful 3 adults worldwide will create AF, a type of arrhythmia characterized by abnormal accelerated irregular heartbeats. If anti-arrhythmic narcotics (AADs) are not successful, a process called ablation tin beryllium utilized to destruct mini sections of bosom insubstantial that whitethorn beryllium causing abnormal heartbeats.

Explaining a caller attack to ablation, Principal Investigator, Professor Daehoon Kim from Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea, said: "Ablation utilizing pulmonary vein isolation (PVI) is nan modular curen for AF, but location is sizeable scope for improvement, peculiarly successful patients who person persistent AF. We person developed a personalized method that uses integer copy exertion to accurately place circumstantial areas of an individual patient's atrium - called shape singularity (PS) points - that look to beryllium causing persistent AF successful a simulation. In nan CUVIA-PRR trial, we investigated whether combining PVI pinch ablation based connected digital-twin guidance is much effective than PVI alone."

This investigator-initiated, randomized superiority proceedings was conducted astatine 4 centres successful South Korea. Patients pinch persistent AF refractory to AADs undergoing first-time AF ablation were included. Patients pinch paroxysmal AF aliases imperishable AF were excluded. Participants were randomizsed 1:1 to either PVI pinch integer twin-guided ablation targeting unchangeable PS points aliases PVI alone. For participants successful nan integer twin-guided ablation group, maps were generated earlier starting PVI to place immoderate unchangeable PS points. AAD usage was allowed during a 3-month blanking play aft ablation but was discouraged aft this. The superior endpoint was immoderate documented atrial arrhythmia lasting ≥30 s aft nan blanking period, pinch aliases without nan usage of AADs.

A full of 304 participants were randomized and completed nan blanking period. Participants had a median property of 61.3 years and 20.7% were women. Stable PS points were identified and ablated successful 43.2% of patients assigned to nan integer twin-guided ablation group.

At 18 months aft ablation, state from recurrent atrial arrhythmia was importantly higher successful nan integer twin-guided ablation group compared pinch nan PVI unsocial group (77.9% vs. 59.5%; hazard ratio [HR] 0.52; 95% CI 0.33 to 0.82; log-rank p=0.004). Freedom from recurrent atrial arrhythmia without AAD usage was much predominant successful nan integer twin-guided ablation group (45.7%) than successful nan PVI unsocial group (31.7%; HR 0.74; 95% CI 0.55 to 0.99). AADs were prescribed aft nan 3-month play successful 51.6% of patients successful nan integer twin-guided ablation group and 63.8% of patients successful nan PVI unsocial group. There were nary important differences successful complication rates aliases full process clip betwixt nan groups. Mean full process clip (142 vs. 137 minutes) was comparable betwixt nan integer twin-guided ablation group and nan PVI unsocial group.

Summarizing nan findings, Professor Kim concluded: "Among patients pinch persistent AF, integer twin-guided ablation positive PVI importantly improved arrhythmia-free endurance compared pinch PVI alone. Previous methods adopting a azygous attack to amended PVI occurrence rates person not been effective and artificial intelligence-guided ablation was recovered to prolong process time. Our tailored, patient-specific ablation attack improved outcomes by precisely targeting nan individual mechanisms underlying AF, without compromising information aliases extending process time."