Aggressive Ablation Better Than Regular for AF

TOPLINE:

Aggressive ablation provided more favorable outcomes at 12 months than regular ablation in patients with persistent atrial fibrillation (AF). Patients undergoing aggressive ablation also had enhanced AF and atrial tachycardia (AT)–free survival.

METHODOLOGY:

• Previous studies suggest using aggressive ablation for persistent AF, but real-world evidence with the approach is lacking.
• Researchers conducted a retrospective cohort study using data from 4833 patients with persistent AF undergoing catheter ablation at 10 clinical sites in China from 2019 to 2023.
• After propensity score matching, two groups (n = 1560 patients each) were established. One group received regular ablation (mean age, 72.59 years; 61.8% men); the other received aggressive ablation (mean age, 72.5 years; 59.2% men).
• Patients in the group receiving regular ablation underwent pulmonary vein isolation (PVI) alone or PVI plus anatomical ablation, whereas those in the aggressive treatment group underwent PVI, anatomical ablation, and extensive electrogram-guided ablation.
• The primary endpoint was freedom from any episode of AF or AT lasting more than 30 seconds after the blanking period (five half-lives before the end of the first 3 months) without the use of anti-arrhythmic drugs at the 12-month follow-up.

TAKEAWAY:

• A higher proportion of patients in the aggressive ablation group than in the regular ablation group achieved freedom from recurrence of AF and AT (66.2% vs 59.3%; P < .001) and AF alone (78.1% vs 70.6%; P < .001), with no significant differences in the incidence of adverse events between the groups.
• Patients receiving aggressive ablation experienced a higher rate of procedural AF termination than did those in the other group (67% vs 21%; P < .001). Patients who experienced AF termination showed improved AF/AT-free survival (hazard ratio, 0.596; 95% CI, 0.514-0.691).
• Patients who underwent aggressive ablation had higher rates of both AF/AT-free survival (67.5% vs 59.9%; P < .001) and AF-free survival (78.7% vs 70.3%; P < .001) than those from the regular group who underwent anatomical ablation alone.
• Moderately aggressive ablation involving two attempts during a single procedure was associated with improved clinical outcomes.

IN PRACTICE:

“Aggressive ablation resulted in more favorable outcomes than regular ablation, with moderately aggressive ablation potentially offering the best clinical outcomes. AF termination appears to be a reliable ablation endpoint,” the authors wrote.

SOURCE:

This study was led by Kaige Li, MD, from the Shanghai Chest Hospital in Shanghai, China. It was published online on March 6, 2025, in EP Europace.

LIMITATIONS:

Because of its retrospective real-world nature, the study lacked randomization, particularly in terms of baseline matching for analyzing the effect of ablation aggressiveness on outcomes. The reproducibility of the strategy across different centers might have been affected by the subjectivity in identifying target electrograms. The 12-month follow-up period restricted the identification of late AF/AT recurrences, and asymptomatic AF episodes might have been underestimated due to the absence of implantable event recorders.

DISCLOSURES:

This study was supported by grants from the National Natural Science Foundation of China. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.