MRI Guided Fibrosis Ablation With PVI No Better Than PVI Alo
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Myocardial fibrosis is key for atrial fibrillation (AF) maintenance. Researchers aimed to test the efficacy of ablating cardiac magnetic resonance (CMR)-detected atrial fibrosis plus pulmonary vein isolation (PVI).

This was an open label, parallel-group, randomized, controlled trial. Patients with symptomatic drug-refractory AF (paroxysmal and persistent) undergoing first or repeat ablation were randomized in a 1:1 basis to receive PVI plus CMR-guided fibrosis ablation (CMR group) or PVI alone (PVI-alone group).

The primary endpoint was the rate of recurrence at 12 months of follow-up using a 12-lead ECG and Holter monitoring at 3, 6, and 12 months. The analysis was conducted by intention-to-treat.

Results
-- Out of total 155 patients, 76 were allocated to the PVI-alone group and 79 to the CMR group.

-- First ablation was performed in 80% and 71% of patients in the PVI-alone and CMR groups, respectively. The mean atrial fibrosis burden was 12% (only ?50% of patients had fibrosis outside the pulmonary vein area).

-- 100% and 99% of patients received the assigned intervention in the PVI-alone and CMR group, respectively.

-- The primary outcome was achieved in 21 patients (27.6%) in the PVI-alone group and 22 patients (27.8%) in the CMR group.

-- There were no differences in the rate of adverse events (3 in the CMR group and 2 in the PVI-alone group).

Conclusively, a pragmatic ablation approach targeting CMR-detected atrial fibrosis plus PVI was not more effective than PVI alone in an unselected population undergoing AF ablation with low fibrosis burden.

Source: https://www.ahajournals.org/doi/10.1161/CIRCEP.120.008707
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