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Background <p>Pulmonary vein isolation (PVI) is the cornerstone of interventional treatment for atrial fibrillation. Patients with persistent atrial fibrillation have relatively high recurrence rates after catheter ablation irrespective of treatment strategy. Randomized data suggest that adding substrate modification to PVI at the first ablation procedure does not improve arrhythmia-free survival. To date, real-world data from experienced centers is limited.</p> Methods and results <p>The German Ablation registry maintained by the Institut für Herzinfarktforschung Ludwigshafen, Germany included 909 patients with persistent atrial fibrillation (AF). 645 underwent isolated PVI (PVI-only) and 264 received additional substrate modification (PVI-plus). The primary endpoint was defined as freedom from AF after 1&#xa0;year documented by ECG. Mean procedure time was longer in the PVI-plus group (203 ± 75&#xa0;min vs. 186 ± 68&#xa0;min; <i>p</i> = 0.002) with no significant difference in acute procedural success (94% PVI-only vs. 97% PVI-plus; <i>p</i> = 0.11). The AF recurrence during index hospital stay was equal between groups (PVI-only 7.4% vs. PVI-plus 9.5%; <i>p</i> = 0.31). After a mean follow-up of 481 ± 139 vs. 492 ± 164&#xa0;days the AF free survival was significantly higher in the PVI-only group compared to PVI-plus group on antiarrhythmic drugs (56.8% vs. 40.8%, <i>p</i> &lt; 0.001) as well as off antiarrhythmic drugs (43.1% vs. 31.4%; <i>p</i> = 0.001).</p> Conclusions <p>The retrospective analysis of prospectively collected data from the German Ablation registry found no evidence that additional substrate modification beyond pulmonary vein isolation during the first ablation procedure for persistent atrial fibrillation improves outcomes.</p> Graphical Abstract <p></p>

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Real word data with no evidence for additional left atrial substrate modification at first PVI procedure in patients with persistent atrial fibrillation - Results from the German Ablation registry

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Elmar Strzelczyk,
  • Clemens Jilek,
  • Johannes Brachmann,
  • Lars Eckardt,
  • Karl-Heinz Kuck,
  • Stephan Willems,
  • Stefan G. Spitzer,
  • Florian Straube,
  • Burghard Schumacher,
  • Dierk Thomas,
  • Hüseyin Ince,
  • Matthias Hochadel,
  • Jochen Senges,
  • Thorsten Lewalter

摘要

Background

Pulmonary vein isolation (PVI) is the cornerstone of interventional treatment for atrial fibrillation. Patients with persistent atrial fibrillation have relatively high recurrence rates after catheter ablation irrespective of treatment strategy. Randomized data suggest that adding substrate modification to PVI at the first ablation procedure does not improve arrhythmia-free survival. To date, real-world data from experienced centers is limited.

Methods and results

The German Ablation registry maintained by the Institut für Herzinfarktforschung Ludwigshafen, Germany included 909 patients with persistent atrial fibrillation (AF). 645 underwent isolated PVI (PVI-only) and 264 received additional substrate modification (PVI-plus). The primary endpoint was defined as freedom from AF after 1 year documented by ECG. Mean procedure time was longer in the PVI-plus group (203 ± 75 min vs. 186 ± 68 min; p = 0.002) with no significant difference in acute procedural success (94% PVI-only vs. 97% PVI-plus; p = 0.11). The AF recurrence during index hospital stay was equal between groups (PVI-only 7.4% vs. PVI-plus 9.5%; p = 0.31). After a mean follow-up of 481 ± 139 vs. 492 ± 164 days the AF free survival was significantly higher in the PVI-only group compared to PVI-plus group on antiarrhythmic drugs (56.8% vs. 40.8%, p < 0.001) as well as off antiarrhythmic drugs (43.1% vs. 31.4%; p = 0.001).

Conclusions

The retrospective analysis of prospectively collected data from the German Ablation registry found no evidence that additional substrate modification beyond pulmonary vein isolation during the first ablation procedure for persistent atrial fibrillation improves outcomes.

Graphical Abstract