Posterior wall ablation, a commonly used adjunct to pulmonary vein isolation (PVI), does not add any benefits for patients undergoing catheter ablation for persistent atrial fibrillation (AF), late-breaking research presented at AF Symposium 2024 (1–3 February, Boston, USA) has shown.
The study, presented by Mohit Turagam (Icahn School of Medicine at Mount Sinai, New York, USA) is the first and the largest study of its kind to analyse the addition of left atrial posterior wall ablation to pulmonary vein isolation while using pulsed-field ablation technology in patients with persistent AFib.
Researchers conducted a retrospective analysis of the MANIFEST-PF registry which included 1,568 patients. In total, 547 of them (34.8%) underwent pulsed field ablation for persistent AF, 131 of these patients (24%) received left atrial posterior wall ablation and pulmonary vein isolation, and 416 (76%) of these patients received pulmonary vein isolation alone.
Results of the study showed that 66% of patients who had left atrial posterior wall ablation combined with pulmonary vein isolation did not have recurring AF after the procedure. Whereas, 73% of patients who had only pulmonary vein isolation did not have recurring AF. The rate of major adverse events was similar among both groups: 2.2% for patients with both types of ablations, compared to 1.4% of patients who had only pulmonary vein isolation.
“The study’s cautionary note about not performing empiric left atrial posterior wall ablation as a purely anatomical approach for persistent AF suggests a need for a more thoughtful and selective approach,” comments Turagam.
The research was simultaneously published in the Journal of the American College of Cardiology: Clinical Electrophysiology.
