Younger atrial fibrillation (AF) patients are most likely to benefit from more personalised, magntetic resonance imaging (MRI)-guided ablation, according to a new analysis of the DECAAF II trial using artificial intelligence (AI). This was the conclusion of research presented by Nassir Marrouche (Tulane University, New Orleans, USA) at the European Society of Cardiology (ESC) congress (25–28 August, Amsterdam, The Netherlands).
The DECAAF II trial tested the hypothesis that imaging-guided fibrosis ablation in addition to conventional pulmonary vein isolation (PVI) is superior to PVI alone in improving ablation success rates in patients with persistent AF. The study initially found that using advanced image-guided technology to target additional diseased areas causing arrhythmias, beyond the usual treatment zones, did not yield superior results compared to simpler methods.
However, researchers looked more closely at the study results using AI-modelling analysis and found screening criteria that could help doctors select patients who would be most likely to benefit from the newer treatments. They concluded that patients younger than 58 years old had the best results.
“This shows that the younger population with AF should be treated very quickly and not wait to get ablation treatment,” said Marrouche. “The earlier we treat an arrhythmia in younger populations, the better they do. In general, people tend to wait until they get older to seek treatment. Our finding is that there are more issues when they are starting therapy then and the outcomes are not as good.”
For the study, researchers followed 843 AF patients undergoing ablation treatment at 44 hospitals in 10 countries, including the USA, Germany, France and Australia. All the patients received MRI scans to quantify the amount of diseased tissue within their hearts.
Half of the patients received standard care—PVI—and for the other half doctors used the MRI scans to create a detailed 3D map of all diseased areas along the left atrium of the heart. They performed conventional PVI treatment and then used the digital map to ablate diseased tissue more aggressively and precisely outside of conventional treatment areas.
All of the study patients received smartphone electrocardiogram (ECG) devices to monitor their heart rhythms daily after treatment, and researchers followed up with them at three-, six- and 12-month intervals.
The study looked at how long it took each group to experience an arrhythmia recurrence after 90 days from treatment. The new analysis showed that patients under 58 years old who underwent fibrosis-guided ablation in addition to PVI experienced significantly lower arrhythmia recurrence rates compared to those who received PVI-only.
“The treatment improved outcomes for these patients by a staggering 50%,” Marrouche said.
Furthermore, the study found that AF burden was significantly lower in younger patients, and there was a higher decrease in left atrial volume in young patients who underwent fibrosis-guided ablation.
“These findings provide valuable insights into the selection of patients for AF ablation procedures and highlight the potential benefits of incorporating fibrosis-guided ablation in younger patients. Further research and clinical trials are needed to validate these results and determine the long-term effects of this approach,” Marrouche said.
