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Combined LAPVI improved sinus rhythm maintenance versus PVI alone in persistent AF patientsCombined Ablation Technique Improves Rhythm Control in Persistent Atrial Fibrillation Patients

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Key Takeaway
Consider LAPVI for persistent AF to improve rhythm control, noting absent safety data.

This randomized controlled trial enrolled 228 patients with persistent atrial fibrillation to compare the effectiveness of combined Left Atrial Posterior Wall Linear Ablation and Pulmonary Vein Isolation (LAPVI) versus PVI alone. The study assessed outcomes at 6 months, 1 year, and 2 years. Safety data, including adverse events and tolerability, were not reported in this publication.

At two years, sinus rhythm maintenance was achieved in 74.77% of the LAPVI group compared to 54.7% in the PVI group (P = 0.002). Recurrence of paroxysmal AF occurred in 11.71% of the LAPVI group versus 24.79% in the PVI group (P < 0.05). Similarly, persistent AF recurrence was 9.01% with LAPVI versus 20.51% with PVI (P < 0.05). Antiarrhythmic drug use was significantly reduced in the LAPVI group at each follow-up interval (P < 0.05).

No safety data, discontinuations, or specific adverse events were reported. The study design and population are clearly defined, but the absence of safety reporting limits the ability to assess the risk-benefit profile. While the results indicate superior rhythm control and reduced medication dependence with LAPVI, the lack of reported safety outcomes and unreported funding or conflict of interest information necessitates cautious interpretation before changing clinical practice.

Researchers investigated whether adding a specific linear ablation to standard pulmonary vein isolation helps patients with persistent atrial fibrillation. The study included 228 patients who received either the combined Left Atrial Posterior Wall Linear Ablation and Pulmonary Vein Isolation (LAPVI) or PVI alone. Participants were followed for up to two years to see how well their heart rhythms were maintained and how often they needed medication.

At the two-year mark, 74.77% of patients in the combined LAPVI group maintained a normal sinus rhythm, compared to 54.7% in the PVI-only group. The rate of atrial fibrillation recurrence was also lower in the combined group, with fewer patients needing antiarrhythmic drugs at every follow-up interval. These differences were statistically significant, suggesting the added procedure offers benefits for rhythm control.

The study did not report specific safety concerns, adverse events, or discontinuations related to the procedure. While the results are encouraging for long-term rhythm stability, readers should note that the study was not designed to prove long-term safety beyond the two-year follow-up. Patients considering this procedure should discuss these findings with their cardiologist to understand how they apply to their specific situation.

What this means for you:
Combined ablation improved rhythm control and reduced drug use in persistent AF patients over two years.

Study Details

Study typeRct
Sample sizen = 228
EvidenceLevel 2
Follow-up6.0 mo
PublishedApr 2026
View Original Abstract ↓
PURPOSE: This study aimed to evaluate whether combining left atrial posterior wall linear ablation with PVI (LAPVI) improves long-term outcomes in patients with persistent AF. METHODS: In a randomized controlled trial, 228 patients with persistent AF underwent PVI and were randomly assigned to either receive additional LAPVI or not. Procedures used a standardized protocol under general anesthesia. Outcomes, including sinus rhythm maintenance and recurrence rates of AF, were assessed at 6 months, 1 year, and 2 years post-procedure. Statistical analysis was performed using the chi-square test for categorical variables and t-tests for continuous variables. RESULTS: At 2 years, 74.77% of the LAPVI group maintained sinus rhythm compared to 54.7% in the PVI group (P = 0.002). Recurrence rates of paroxysmal and persistent AF were significantly lower in the LAPVI group at 11.71% and 9.01%, respectively, versus 24.79% and 20.51% in the PVI group (P < 0.05). Antiarrhythmic drug use was significantly reduced in the LAPVI group at each follow-up interval (P < 0.05). CONCLUSION: LAPVI significantly enhances long-term rhythm control and reduces dependence on antiarrhythmic drugs compared to PVI alone in patients with persistent AF.
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