PROMPT-AF: Novel ablation strategy improves outcomes for persistent AF

In the PROMPT-AF trial, freedom from atrial arrhythmia was more frequently achieved when patients with persistent atrial fibrillation (AF) received a linear ablation strategy optimised with an ethanol infusion of vein of Marshall (EIVOM) plus pulmonary vein isolation (PVI) than if they received PVI alone.

“The benefit of a linear ablation strategy optimised with EIVOM to facilitate mitral isthmus ablation has not yet been established,” according to Prof. Chenyang Jiang (Sir Run Run Shaw Hospital, China) [1]. The investigators designed the randomised PROMPT-AF study (NCT04497376) to compare a linear ablation strategy with EIVOM plus PVI versus PVI alone among Chinese patients with drug-refractory persistent AF (n=498). The primary outcome was freedom from atrial arrhythmia in the absence of antiarrhythmic drug use at 12 months from ablation.

After 1 year of follow-up, a significant benefit was seen for participants allocated to the experimental arm compared with those in the control arm (HR 0.73; 95% CI 0.54–0.99; P_logrank=0.045). The corresponding arrhythmia-free rates were 70.7% and 61.5% (see Figure). There were 7 cases of pericarditis or pericardial effusion not requiring drainage in the EIVOM plus PVI arm compared with only 1 case in the PVI-only arm. Procedural complication rates were otherwise similar for the 2 study arms.

Figure: Freedom from arrhythmia in the absence of anti-arrhythmic drug use 1-year post-ablation [1]



EIVOM, ethanol infusion of vein of Marshall; PVI, pulmonary vein isolation.

“The PROMPT-AF trial is the first randomised study to show that a linear ablation strategy including EIVOM and PVI significantly reduces atrial arrhythmia recurrence compared with PVI alone in patients with persistent AF,” concluded Prof. Jiang.

“After these findings in patients undergoing radiofrequency ablation, the next question to address is whether the benefits are the same in patients undergoing pulsed field ablation,” Prof. Jonathan Piccini (Duke University, NC, USA) suggested after the presentation of Dr Jiang.

1. 
   
   1. Jiang C, et al. Comparison of linear ablation plus pulmonary vein isolation versus pulmonary vein isolation alone for persistent atrial fibrillation. LBS.07, AHA Scientific Sessions 2024, 16–18 November, Chicago, USA.

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Posted on 3 February 2025