Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: The EARNEST-PVI trial

Koichi Inoue, Shungo Hikoso, Masaharu Masuda, Yoshio Furukawa, Akio Hirata, Yasuyuki Egami, Tetsuya Watanabe, Hitoshi Minamiguchi, Miwa Miyoshi, Nobuaki Tanaka, Takafumi Oka, Masato Okada, Takashi Kanda, Yasuhiro Matsuda, Masato Kawasaki, Kenichi Hayashi, Tetsuhisa Kitamura, Tomoharu Dohi, Akihiro Sunaga, Hiroya MizunoDaisaku Nakatani, Yasushi Sakata

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Previous studies could not demonstrate any benefit of more intensive ablation in addition to pulmonary vein isolation (PVI) including complex fractionated atrial electrogram (CFAE) and linear ablation for recurrence in the initial catheter ablation of persistent atrial fibrillation (AF). This study aimed to establish the non-inferiority of PVI alone to PVI plus these additional ablation strategies. Methods and results: Patients with persistent AF who underwent an initial catheter ablation (n = 512, long-standing persistent AF; 128 cases) were randomly assigned in a 1:1 ratio to either PVI alone (PVI-alone group) or PVI plus CFAE and/or linear ablation (PVI-plus group). After excluding 15 cases who did not receive procedures, we analysed 249 and 248 patients, respectively. The primary endpoint was recurrence of AF, atrial flutter, and/or atrial tachycardia, and the non-inferior margin was set at a hazard ratio of 1.43. In the PVI-plus group, 85.1% of patients had linear ablation and 15.3% CFAE ablation. After 12 months, freedom from the primary endpoint occurred in 71.3% of patients in the PVI-alone group and in 78.3% in the PVI-plus group [hazard ratio = 1.56 (95% confidence interval: 1.10-2.24), non-inferior P = 0.3062]. The procedure-related complication rates were 2.0% in the PVI-alone group and 3.6% in the PVI-plus group (P = 0.199). Conclusion: This randomized trial did not establish the non-inferiority of PVI alone to PVI plus linear ablation or CFAE ablation in patients with persistent AF, but implied that the PVI plus strategy was promising to improve the clinical efficacy (NCT03514693).

Original languageEnglish
Pages (from-to)565-574
Number of pages10
JournalEuropace
Volume23
Issue number4
DOIs
Publication statusPublished - 2021 Apr 1

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Linear ablation
  • Persistent atrial fibrillation
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint

Dive into the research topics of 'Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: The EARNEST-PVI trial'. Together they form a unique fingerprint.

Cite this