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Mapping-Guided Ablation for Persistent Atrial Fibrillation (MAP-AF): A Multicenter, Single-Blind, Randomized Controlled Trial.
Takahashi, Yoshihide; Kobori, Atsushi; Hiroshima, Kenichi; Sakamoto, Yuichiro; Kimura, Masaomi; Inaba, Osamu; Tanimoto, Kojiro; Hanazawa, Ryoichi; Hirakawa, Akihiro; Goya, Masahiko; Sasano, Tetsuo.
Afiliación
  • Takahashi Y; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences (Y.T., M.G., T.S.).
  • Kobori A; Department of Cardiology, Shin-Yurigaoka General Hospital, Kawasaki (Y.T.).
  • Hiroshima K; Department of Cardiology, Kobe City Medical Center General Hospital, Japan (A.K.).
  • Sakamoto Y; Department of Cardiology, Kokura Memorial Hospital, Japan (K.H.).
  • Kimura M; Department of Cardiovascular Medicine, Toyohashi Heart Center, Japan (Y.S.).
  • Inaba O; Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (M.K.).
  • Tanimoto K; Department of Cardiology, Japanese Red Cross Saitama Hospital, Japan (O.I.).
  • Hanazawa R; Department of Cardiology, Tokyo Medical Center, Japan (K.T.).
  • Hirakawa A; Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan (R.H., A.H.).
  • Goya M; Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan (R.H., A.H.).
  • Sasano T; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences (Y.T., M.G., T.S.).
Circ Arrhythm Electrophysiol ; 17(8): e012829, 2024 Aug.
Article en En | MEDLINE | ID: mdl-39051110
ABSTRACT

BACKGROUND:

The clinical outcome of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) is suboptimal. Mapping studies have demonstrated atrial sites outside of the pulmonary veins displaying focal activation patterns during AF. We sought to determine whether adding catheter ablation of focal activation sites to PVI improves clinical outcomes of catheter ablation for persistent AF.

METHODS:

In this multicenter, randomized, single-blinded trial, we assigned patients with persistent AF to either PVI alone or to mapping-guided ablation of focal activation sites in addition to PVI in a 11 ratio. In the mapping-guided group, both atria were mapped after PVI using a Pentaray catheter (Biosense-Webster) and focal activation sites identified by CARTOFINDER (Biosense-Webster) were ablated. The primary end point was freedom from AF or atrial tachycardia without antiarrhythmic drugs beyond a 90-day blanking period.

RESULTS:

A total of 98 patients were assigned to the mapping-guided group and 102 to the PVI alone group. In the mapping-guided group, focal activation sites were identified at 2.6±0.3 and 2.5±0.2 sites per patient in the left and right atrium, respectively. Patients were followed up for 768.5 (interquartile range, 723.75-915.75) and 755.5 days (interquartile range, 728.5-913.75) in the mapping-guided ablation and the PVI alone groups, respectively. Freedom from AF/atrial tachycardia without antiarrhythmic drugs at 2-year follow-up was 66.8% and 75.2% in the mapping-guided ablation and the PVI alone groups, respectively (hazard ratio, 1.26 [95% CI, 0.76-2.10]; P=0.37). Adverse events occurred in 3 patients (3.0%) and none (0%) in the mapping-guided ablation and the PVI alone groups, respectively (P=0.12).

CONCLUSIONS:

In patients with persistent AF, the addition of mapping-guided ablation of focal activation sites to PVI did not improve clinical outcomes compared with PVI alone. REGISTRATION URL https//center6.umin.ac.jp/cgi-open-bin/ctr/index.cgi?function=02; Unique identifier UMIN000037569.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Venas Pulmonares / Fibrilación Atrial / Ablación por Catéter Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Venas Pulmonares / Fibrilación Atrial / Ablación por Catéter Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos