Catheter ablation for persistent atrial fibrillation: A multicenter randomized trial of pulmonary vein isolation (PVI) versus PVI with posterior left atrial wall isolation (PWI) - The CAPLA study - 26/11/21

Doi : 10.1016/j.ahj.2021.09.015

David Chieng, MBBS ^a,^b,^c,^d, Hariharan Sugumar, MBBS, PhD ^a,^b,^c,^d, Liang-Han Ling, MBBS, PhD ^a,^b,^c,^h, Louise Segan, MBBS ^a,^b,^c,^d, Sonia Azzopardi, RN ^a,^b, Sandeep Prabhu, MBBS, PhD ^a,^b,^c,^g, Ahmed Al-Kaisey, MBBS ^c,^f, Aleksandr Voskoboinik, MBBS, PhD ^a,^b,^c,^d, Ramanathan Parameswaran, MBBS, PhD ^c,^f, Joseph B Morton, MBBS, PhD ^c,^f, Bhupesh Pathik, MBBS, PhD ^c,^f, Alex J McLellan, MBBS, PhD ^c,^f,^h, Geoffrey Lee, MBChD, PhD ^c,^f, Michael Wong, MBBS, PhD ^c,^f,ⁱ, Sue Finch, PhD ^c, Rajeev K Pathak, MBBS, PhD ^j,^k, Deep Chandh Raja, MBBS, MD ^j,^k, Prashanthan Sanders, MBBS, PhD ^l, Laurence Sterns, MD ^m, Matthew Ginks, MD ⁿ, Christopher M Reid, MBBS, PhD ^e,^o, Jonathan M Kalman, MBBS, PhD, FHRS ^c,^e,^f, Peter M Kistler, MBBS, PhD, FHRS ^a,^b,^c,^d,^e,^p,^⁎
^a The Alfred Hospital, Melbourne, Australia,
^b The Baker Heart and Diabetes Research Institute, Melbourne, Australia
^c University of Melbourne, Melbourne, Australia
^d Cabrini Hospital, Melbourne, Australia
^e Monash University, Melbourne, Australia
^f Royal Melbourne Hospital, Melbourne, Australia
^g Mulgrave Private Hospital, Melbourne, Australia
^h St Vincent's Private Hospital Fitzroy, Melbourne Australia
ⁱ Epworth Hospital Richmond, Melbourne, Australia
^j Canberra Hospital, ACT, Australia
^k Australian National University, ACT, Australia
^l Royal Adelaide Hospital, Adelaide, Australia
^m Royal Jubilee Hospital, Vancouver Island, British Columbia, Canada
ⁿ John Radcliffe Hospital, Oxford, UK
^o Curtin University, Perth, Australia
^p Melbourne Private Hospital, Melbourne, Australia

^⁎Reprint requests: Peter M Kistler, MBBS, PhD, FHRS, Heart Center, The Alfred Hospital. 55 Commercial Road, Melbourne 3004 Australia.Peter M Kistler, MBBS, PhD, FHRS, Heart Center55 Commercial RoadMelbourne3004Australia

Résumé

Background

The success of pulmonary vein isolation (PVI) is reduced in persistent AF (PsAF) compared to paroxysmal AF. Adjunctive ablation strategies have failed to show consistent incremental benefit over PVI alone in randomized studies. The left atrial posterior wall is a potential source of non-PV triggers and atrial substrate which may promote the initiation and maintenance of PsAF. Adding posterior wall isolation (PWI) to PVI had shown conflicting outcomes, with earlier studies confounded by methodological limitations.

Objectives

To determine whether combining PWI with PVI significantly improves freedom from AF recurrence, compared to PVI alone, in patients with PsAF.

Methods

This is a multi-center, prospective, international randomized clinical trial. 338 patients with symptomatic PsAF refractory to anti-arrhythmic therapy (AAD) will be randomized to either PVI alone or PVI with PWI in a 1:1 ratio. PVI involves wide antral circumferential pulmonary vein (PV) isolation, utilizing contact force sensing ablation catheters. PWI involves the creation of a floor line connecting the inferior aspect of the PVs, and a roof line connecting the superior aspect of the PVs. Follow up is for a minimum of 12 months with rhythm monitoring via implantable cardiac device and/or loop monitor, or frequent intermittent monitoring with an ECG device. The primary outcome is freedom from any documented atrial arrhythmia of > 30 seconds off AAD at 12 months, after a single ablation procedure.

Conclusions

This randomized study aims to determine the success and safety of adjunctive PWI to PVI in patients with persistent AF.

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Vol 243

P. 210-220 - janvier 2022 Retour au numéro

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Catheter ablation for persistent atrial fibrillation: A multicenter randomized trial of pulmonary vein isolation (PVI) versus PVI with posterior left atrial wall isolation (PWI) - The CAPLA study - 26/11/21

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Background

Objectives

Methods

Conclusions

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