Posterior Wall Ablation Does Not Help Patients With Persistent Atrial Fibrillation

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Posterior Wall Ablation Does Not Help Patients With Persistent Atrial Fibrillation
Mount Sinai research shows no added benefit to this additional step

Conference: AF Symposium - Late Breaking Clinical Science Session 1

Thursday, February 1, 7pm EST

“Impact of Left Atrial Posterior Wall Ablation During Pulsed Field Ablation for Persistent Atrial Fibrillation: A MANIFEST-PF Registry Sub-Study”

Journal: Simultaneous publication in the Journal of the American College of Cardiology: Clinical Electrophysiology

Authors: Mohit Turagam, MD, Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai

Vivek Reddy, MD, The Leona M. and Harry B. Helmsley Charitable Trust Professor of Medicine in Cardiac Electrophysiology at Icahn Mount Sinai

Bottom line: Posterior wall ablation, a commonly used adjunct to pulmonary vein isolation (PVI), doesn’t add any benefits for patients undergoing catheter ablation for persistent atrial fibrillation (AFib).

Performing a left atrial posterior wall ablation along with PVI with pulsed field ablation (high-energy electrical pulses that target cardiac cells causing irregular heartbeat) may not have an added benefit for patients with persistent AFib—an irregular heartbeat that lasts for more than seven days.

Standard treatment for persistent AFib is a PVI ablation, but in a majority of these cases, cardiac electrophysiologists add on left atrial posterior wall ablation. This study shows there’s no added benefit to adjunctive left atrial posterior wall ablation with PVI for eliminating AFib and cardiologists should be more selective when choosing this option.

Why this study is unique: This is the first and the largest study of its kind to analyze the addition of left atrial posterior wall ablation to pulmonary vein isolation while using pulsed-field ablation technology in patients with persistent AFib.

Why the study is important: Treating patients with persistent AFib and resolving their symptoms can be challenging. This study demonstrates the importance of exploring additional strategies to enhance outcomes and moving away from ablation techniques that may not be effective in this patient group.

How the research was conducted: Researchers conducted a retrospective analysis of the MANIFEST-PF registry which included 1,568 patients. 547 of them (34.8 percent) underwent pulsed field ablation for persistent AFib. 131 of these patients (24 percent) received left atrial posterior wall ablation and pulmonary vein isolation, and 416 (76 percent) of these patients received pulmonary vein isolation alone.

Results: 66 percent of patients who had left atrial posterior wall ablation combined with pulmonary vein isolation did not have recurring AFib after the procedure. 73 percent of patients who had only pulmonary vein isolation did not have recurring AFib. The rate of major adverse events was similar among both groups: 2.2 percent for patients with both types of ablations, compared to 1.4 percent of patients who had only pulmonary vein isolation.

What this study means for cardiologists and patients: Empiric inclusion of left atrial posterior wall ablation should not be routinely performed in patients with persistent AFib. The negative study findings suggest that the addition of left atrial posterior wall ablation did not improve clinical outcomes in patients with persistent AFib. Importantly, there were no instances of esophageal injury, including ulceration or atrioesophageal fistulas, in either group.

Quotes: "The study's cautionary note about not performing empiric left atrial posterior wall ablation as a purely anatomical approach for persistent AFib suggests a need for a more thoughtful and selective approach." says Dr. Turagam.

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