CEASE-AF meets primary endpoint in persistent AF

The primary results of the CEASE-AF trial demonstrated that hybrid ablation, epicardial plus endocardial ablation, was superior to endocardial ablation alone in reducing atrial arrhythmias in patients with persistent and longstanding persistent atrial fibrillation (AF), without increasing adverse events.

The prospective CEASE-AF trial (NCT02695277) randomised 170 patients with persistent AF and enlarged left atria or longstanding persistent AF 2:1 to hybrid ablation or endocardial catheter ablation [1]. In the hybrid ablation arm, patients first underwent epicardial ablation, followed by a 90-day blanking period and subsequent endocardial ablation. The primary efficacy outcome was the freedom from AF, atrial flutter, or atrial tachycardia >30 seconds through 12 months. Prof. Nicolas Doll (Georg-August University, Germany) presented the primary results of the trial.

The primary endpoint was reached by 71.6% of the participants in the hybrid arm and by 39.2% of the participants in the endocardial ablation arm, representing a significant difference in efficacy between the 2 study arms (P<0.001). Furthermore, the rates of ‘repeat ablations’ (4.2% vs 35.3%; P<0.001) and cardioversions (11.6% vs 25.5%; P=0.037) were lower in the intervention arm. Notably, no significant difference was observed in terms of safety: the composite complication rate at 30 days post-index and 30 days post-second stage plus repeat ablation were 7.8% in the intervention arm and 5.8% in the control arm (P=0.75). Prof. Doll stressed that the success of an epicardial-endocardial approach emphasises the role of a collaborative heart team approach in the treatment of non-paroxysmal AF.

1. 1. Doll N, et al. Effectiveness and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: primary results of the CEASE-AF trial. Late-Breaking Science Day 2, EHRA 2023, 16–18 April, Barcelona, Spain.

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