Catheter ablation for patients with persistent atrial fibrillation (AF) (when episodes last a week to a year or more) is much less effective than for patients with paroxysmal AF.
To boost catheter ablation's chances for success in persistent AF pulmonary vein isolation (PVI) is often augmented with further ablation posterior wall isolation (PWI). But the add-on strategy has had mixed success in the literature.
The results of CAPLA trial (Catheter Ablation for persistent atrial fibrillation) in preliminary was presented form last August at the European Society of Cardiology (ESC) Congress 2022 and was published in January 10 (2023) in the JAMA Journal.
In this randomized clinical trial that included 338 patients with persistent AF (median age, 65.6 [IQR, 13.1] years; 76.9% men), there was no significant difference in 12-month freedom from recurrent atrial arrhythmia after a single procedure and without antiarrhythmic medication among those with PVI and PWI compared with PVI alone (52.4% vs 53.6%, respectively; hazard ratio, 0.99).
Among patients with persistent AF undergoing first-time catheter ablation, the addition of PVI to PVI did not improve freedom from atrial arrhythmias compared with PVI alone.