Low-voltage-area (LVA) ablation plus PCI was not superior to PCI alone in patients with persistent atrial fibrillation (AF) with respect to recurrence of AF. However, patients with advanced left atrial remodeling did appear to benefit from the addition of LVA ablation to PCI.
In the SUPPRESS-AF trial, participants with persistent AF, left atrial LVA >5cm^2, and undergoing a first ablation (n=341) were randomly assigned 1:1 to PCI plus LVA ablation or PCI alone. The primary endpoint was 1-year freedom from AF/atrial tachycardia (AT) recurrence after initial ablation. Masaharu Masuda, MD, Kansai Rosai Hospital, Japan, presented the findings.
Freedom from AF/AT recurrence at 1 year was reported in 61% of the participants in the LVA ablation group and 50% of those in the PVI group, a non-significant difference (HR 0.79; 95% CI 0.56–1.08; log-rank P=0.13). “A subgroup analysis showed that the efficacy of LVA ablation may be more pronounced in patients with advanced atrial remodeling,” mentioned Dr. Masuda. Participants with a CHA2DS2VASc score of four or higher, those with an NYHA class of II or higher, a left atrial diameter (≥45 mm), or an LVA size( ≥20 cm^2) appeared to have a larger benefit from the additional LVA ablation procedure than participants without these features. Finally, there was no substantial difference between the two arms with respect to safety.
“LVA ablation in addition to PVI is not recommended as a routine procedure for persistent AF,” concluded Dr. Masuda. “However, if the patient has left atrial remodeling, LVA ablation could be a therapeutic option.”
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