https://doi.org/10.55788/1f0c654f
ASTRO AF (NCT04056390) is a multicentre, randomised trial comparing empirical ablation with LAAI using a cryoballoon and staged interventional LAAC with an individualised technique consisting of ablation of left atrial low voltage areas (LVA) using an irrigated radiofrequency current and a 3D mapping system [1].
Participants were included if they had symptomatic AF (no atrial tachycardia) despite prior pulmonary vein isolation. The primary endpoint of the trial was arrhythmia-free survival between days 90 and 365 following ablation. In total, 161 participants were randomised, of whom 32% had paroxysmal AF and 66% had permanent AF; 47% of the participants had 1 prior ablation procedure, and 40% had 2 prior procedures. Dr Boris Schmidt (Cardioangiologisches Centrum Bethanien, Germany) presented the results.
Using 72-hour Holter measurements at 3, 6, and 12 months, no statistically significant difference was found between groups in terms of arrhythmia-free survival (P=0.81). At the 12-month timepoint, the arrhythmia-free survival rate with LAAI/LVA was 51.7%, compared with 55.5% with the radiofrequency procedure. In terms of safety, there was a numerically higher number of complications in the LAAI/LVA group (13.4% vs 5.0%; P=0.1022).
In summary, the primary endpoint of the trial was not met, with cryoballoon LAAI/LVA not proving superior to radiofrequency ablation. Due to these results, Dr Schmidt stressed that “the study was prematurely halted for futility after randomisation of 63% of the planned patient population.”
- Schmidt B, et al. Ablation STrategies for Repeat PrOcedures in patients with Atrial Fibrillation recurrences despite durable pulmonary vein isolation. Late-Breaking Science: ablation. EHRA Congress 2024, 7–9 April, Berlin, Germany.
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Table of Contents: EHRA 2024
Featured articles
PIRECNA: Cardioneuroablation is feasible for vagally-induced atrioventricular block
ARTESiA: Stroke risk unaffected by subclinical atrial fibrillation duration
Personalising Ablation Techniques
Ablate-by-LAW: CT-determined left atrial wall thickness for ablation titration in atrial fibrillation
Personalised LAWT-guided ablation non-inferior to CLOSE protocol for paroxysmal atrial fibrillation
Style-AF: Improved outcomes with vascular closure versus figure-of-eight suture
Advantage of PREVENTIVE ablation plus implantable cardioverter-defibrillator in ischaemic cardiomyopathy
ASTRO AF: No benefit of staged left atrial appendage isolation cryoballoon ablation over radiofrequency ablation
Innovative Ablation Strategies
Pulsed-field ablation vs high-power short-duration radiofrequency in paroxysmal AF
CryoCure-VT: Endocardial ultra-low temperature cryoablation effective in sustained monomorphic ventricular tachycardia
PIRECNA: Cardioneuroablation is feasible for vagally-induced atrioventricular block
MRI head-to-head comparison of lesion quality following various ablation techniques
“Single-shot” conformable catheter shows promising efficacy in paroxysmal atrial fibrillation
Post-Ablation Recurrence
AF burden versus classical AF classification in predicting arrhythmia recurrence
ARTESiA: Stroke risk unaffected by subclinical atrial fibrillation duration
Ablation strategy and the number of repeat procedures not associated with atrial fibrillation recurrence
Factors associated with negative outcomes in post-operative atrial fibrillation
Arrhythmia Technologies
Smartphone rhythm monitoring optimises AF management following cardiac surgery
SMART-AV and SMART-CRT: Improved cardiac outcomes with algorithm-adapted atrioventricular delay
Premature battery depletion can affect a quarter of subcutaneous cardioverter defibrillators
New atrial fibrillation associated with a high risk of major cardiovascular outcomes
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