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Impact of Posterior Left Atrial Voltage on Ablation Outcomes in Persistent Atrial Fibrillation: CAPLA Substudy

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dc.contributor.authorChieng, D.
dc.contributor.authorSugumar, H.
dc.contributor.authorHunt, A.
dc.contributor.authorLing, L.-H.
dc.contributor.authorSegan, L.
dc.contributor.authorAl-Kaisey, A.
dc.contributor.authorHawson, J.
dc.contributor.authorPrabhu, S.
dc.contributor.authorVoskoboinik, A.
dc.contributor.authorWong, G.
dc.contributor.authorMorton, J.B.
dc.contributor.authorLee, G.
dc.contributor.authorGinks, M.
dc.contributor.authorSterns, L.
dc.contributor.authorSanders, P.
dc.contributor.authorKalman, J.M.
dc.contributor.authorKistler, P.M.
dc.date.issued2023
dc.description.abstractBACKGROUND Pulmonary vein isolation (PVI) is less effective in patients with persistent atrial fibrillation (PsAF). Adjunctive ablation targeting low voltage areas (LVAs) may improve arrhythmia outcomes. OBJECTIVES This study aims to compare the outcomes of adding posterior wall isolation (PWI) to PVI, vs PVI alone in PsAF patients with posterior wall LVAs. METHODS The CAPLA (Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation) study was a multicenter, randomized trial involving PsAF patients randomized 1:1 to either PVI alone or PVI with PWI. Voltage mapping performed during pacing pre-ablation was reviewed offline, with LVA defined as bipolar voltage of <0.5 mV. The primary endpoint was freedom from any documented atrial arrhythmia of >30 seconds off antiarrhythmic medication at 12 months after a single ablation procedure in patients with posterior LVA. RESULTS A total of 210 patients (average 64.6 ± 9.2 years,73.3% males, median atrial fibrillation duration 4.5 months [IQR: 2 to 8 months]) underwent multipolar left atrial mapping during coronary sinus pacing with posterior LVA present in 69 (32.9%). Patients with posterior LVA were more likely to have LVA in other atrial regions (91.7% vs 57.1%; P < 0.01), larger left atrial diameter (4.8 cm vs 4.4 cm; P < 0.01), and significantly increased risk of atrial arrhythmia recurrence at 12 months (LVA: 56.5% vs no LVA: 41.4%; HR: 1.51; 95% CI: 1.01-2.27; P 1/4 0.04) compared to no posterior LVA. However, the addition of PWI to PVI did not significantly improve freedom from atrial arrhythmia recurrence over PVI alone (PVI with PWI: 44.8% vs PVI: 41.9%; HR: 0.95; 95% CI: 0.51-1.79; P = 0.95). CONCLUSIONS In patients with PsAF undergoing catheter ablation, posterior LVA was associated with a significant increase in atrial arrhythmia recurrence. However, the addition of PWI in those with posterior LVA did not reduce atrial arrhythmia recurrence over PVI alone.
dc.description.statementofresponsibilityDavid Chieng, Hariharan Sugumar, Andrew Hunt, Liang-Han Ling, Louise Segan, Ahmed Al-Kaisey, Joshua Hawson, Sandeep Prabhu, Aleksandr Voskoboinik, Geoffrey Wong, Joseph B. Morton, Geoffrey Lee, Matthew Ginks, Laurence Sterns, Prashanthan Sanders, Jonathan M. Kalman, Peter M. Kistler
dc.identifier.citationJACC: Clinical Electrophysiology, 2023; 9(11):2291-2299
dc.identifier.doi10.1016/j.jacep.2023.08.002
dc.identifier.issn2405-500X
dc.identifier.issn2405-5018
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttps://hdl.handle.net/2440/142013
dc.language.isoen
dc.publisherElsevier
dc.relation.grantNHMRC
dc.rights© 2023 by the American College of Cardiology Foundation. Published by Elsevier.
dc.source.urihttps://doi.org/10.1016/j.jacep.2023.08.002
dc.subjectatrial fibrillation
dc.subjectcatheter ablation
dc.subjectlow voltage area
dc.subjectposterior wall isolation
dc.subjectpulmonary vein isolation
dc.subject.meshPulmonary Veins
dc.subject.meshHeart Atria
dc.subject.meshAtrial Appendage
dc.subject.meshHumans
dc.subject.meshAtrial Fibrillation
dc.subject.meshCatheter Ablation
dc.subject.meshTreatment Outcome
dc.subject.meshFemale
dc.subject.meshMale
dc.titleImpact of Posterior Left Atrial Voltage on Ablation Outcomes in Persistent Atrial Fibrillation: CAPLA Substudy
dc.typeJournal article
pubs.publication-statusPublished

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