Author + information
- Received May 21, 2019
- Revision received August 26, 2019
- Accepted August 29, 2019
- Published online November 18, 2019.
- Jung Myung Lee, MD, PhDa,
- Jaemin Shim, MD, PhDb,
- Junbeom Park, MD, PhDc,
- Hee Tae Yu, MD, PhDd,
- Tae-Hoon Kim, MDd,
- Jin-Kyu Park, MD, PhDe,
- Jae-Sun Uhm, MD, PhDd,
- Jin-Bae Kim, MD, PhDa,
- Boyoung Joung, MD, PhDd,
- Moon-Hyoung Lee, MD, PhDd,
- Young-Hoon Kim, MD, PhDb,
- Hui-Nam Pak, MD, PhDd,∗ (, )
- for the POBI-AF Investigators
- aKyung Hee University Medical College, Seoul, Republic of Korea
- bKorea University Cardiovascular Center, Seoul, Republic of Korea
- cEwha Womans University, Seoul, Republic of Korea
- dYonsei University Health System, Seoul, Republic of Korea
- eHanyang University, Seoul, Republic of Korea
- ↵∗Address for correspondence:
Dr. Hui-Nam Pak, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Objectives This study explored whether complete electrical isolation of the left atrial (LA) posterior wall improves the rhythm outcome of catheter ablation of persistent atrial fibrillation (AF).
Background Although the STAR AF2 (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II) proved no additional benefit of empirical extra-pulmonary vein (PV) LA ablation, the long-term recurrence rate after circumferential PV isolation (CPVI) alone remains high.
Methods We randomly assigned 217 patients with persistent AF (83.1% men, age 58.7 ± 10.8 years, 73.3% long-standing persistent AF) to ablation with CPVI alone (CPVI group) or CPVI with a POsterior wall Box Isolation (POBI group). The endpoint of the POBI group was the elimination of the posterior atrial potentials by roof and posterior inferior lines and touch-up focal ablation.
Results After a mean follow-up of 16.2 ± 8.8 months, the clinical recurrence rate did not significantly differ between the 2 groups (23.8% vs. 26.5%; p = 0.779) in the CPVI and POBI groups. The recurrence rate for atrial tachycardias (16.0% vs. 11.1%; p = 0.913) and cardioversion rates (6.7% vs. 13.7%; p = 0.093) to control clinical recurrences also did not significantly differ between the 2 groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 50.5% and 55.9% in the CPVI and POBI groups, respectively (p = 0.522). No significant difference was found in the major complication rates between the 2 groups, but the total ablation time was significantly longer in the POBI group (4,289 ± 1,837 s vs. 5,365 ± 2,358 s; p < 0.001).
Conclusions In patients with persistent AF, an empirical complete POBI did not improve the rhythm outcome of catheter ablation or influence the type of recurrent atrial arrhythmia. (Comparison of Circumferential Pulmonary Vein Isolation Alone Versus Linear Ablation in Addition to Circumferential Pulmonary Vein Isolation for Catheter Ablation in Persistent Atrial Fibrillation: Prospective Randomized Controlled Trial; NCT02721121).
Supported by grants (HI18C0070 and HI19C0114) from the Korea Health 21 R and D Project, Ministry of Health and Welfare, and a grant (NRF-2017R1A2B4003983) from the Basic Science Research Program run by the National Research Foundation of Korea (NRF). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 21, 2019.
- Revision received August 26, 2019.
- Accepted August 29, 2019.
- 2019 American College of Cardiology Foundation
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