Late-breaking results from the PROMPT-AF, CRRF-PeAF and ARREST-AF trials were presented recently at the American Heart Association (AHA) Scientific Sessions (16–18 November 2024, Chicago, USA), shedding new light on the latest approaches to the management of patients with atrial fibrillation (AF).
In PROMPT-AF—also now published in the Journal of the American Medical Association (JAMA)—researchers found that linear ablation combined with ethanol infusion of the vein of Marshall (EIVOM) in addition to pulmonary vein isolation (PVI) significantly improved freedom from atrial arrhythmias within 12 months in patients with persistent AF, as compared to treatment with PVI alone.
Presenting these findings, Chenyang Jiang (Zhejiang University School of Medicine, Hangzhou, China) specifically noted that freedom from atrial arrhythmia recurrence without antiarrhythmic drugs was achieved in 70.7% of patients assigned to PVI plus linear ablation and EIVOM versus 61.5% of those assigned to PVI alone.
In a related editorial comment, Miguel Valderrábano (Houston Methodist Hospital, Houston, USA) writes that the trial results demonstrate the value of EIVOM for improving ablation outcomes in persistent AF.
“Although EIVOM-specific mechanisms, such as parasympathetic denervation, may apply, conceptually, the results provide further proof that improving the reliability of a lesion set—as EIVOM does for the mitral isthmus—can improve outcomes,” he states.
Researchers presenting on the CRRF-PeAF study found that cryoballoon ablation was not inferior to radiofrequency ablation with respect to clinical efficacy in patients with persistent AF at one year.
Additionally, in presenting the findings at AHA 2024, Kengo Kusano (National Cerebral and Cardiovascular Center, Suita, Japan) reported that cryoballoon ablation demonstrated less atrial structural change compared with radiofrequency ablation, despite a similar recurrence rate and AF burden after ablation between the two groups.
In ARREST-AF, aggressive risk factor management was shown to reduce arrhythmia recurrence in the 12 months following catheter ablation when compared with usual care among patients with AF, elevated body mass index (BMI) and one additional cardiometabolic risk factor.
Reporting these findings at AHA 2024, Rajeev Pathak (University of Adelaide/Royal Adelaide Hospital, Adelaide, Australia) noted that the percentage of patients free from AF after ablation—the primary endpoint of the study—was 66% in the risk-factor management group compared with 42% in the usual care group. AF symptom severity and risk-factor profiles were also significantly improved among those receiving risk-factor management compared with usual care.
