Testing a Prospective Ablation Method for Atrial Fibrillation

By Patrick Zakka, MD - March 23, 2023

In a study, published in JAMA Cardiology, researchers compared an augmented double wide-area circumferential ablation (WACA) with the standard single WACA method for preventing atrial arrhythmia recurrences in patients with paroxysmal atrial fibrillation.

However, according to the study’s lead author, Girish Nair, additional ablation for paroxysmal atrial fibrillation with a double lesion strategy did not improve the proportion of patients who achieved freedom from recurrent atrial arrhythmias when compared with the standard ablation.

Augmented Ablation for Atrial Fibrillation Not Superior

The multicenter, prospective, AWARE randomized controlled trial enrolled 398 patients with symptomatic paroxysmal atrial fibrillation undergoing catheter ablation across 10 university-affiliated centers in Canada between March 2015 and May 2017.

Participants received pulmonary vein isolation with either a standard single WACA (n=195) or an augmented double WACA (n=203), followed by 42 days of ambulatory electrocardiography monitoring.

The primary end point of the study was atrial arrhythmia recurrence from 91 to 365 days after the procedure. In total, 52 (26.7%) patients in the standard ablation arm and 50 (24.6%) in the augmented ablation arm had atrial arrhythmia recurrence at 1 year (risk ratio [RR], 0.92; 95% CI, 0.66-1.29; P=.64).

Authors noted 20 (10.3%) and 15 (7.4%) patients needed to undergo repeat catheter ablation (RR, 0.72; 95% CI, 0.38-1.36) in the single and double WACA arm, respectively; additionally, serious adverse events occurred in 13 (6.7%) and 14 (6.9%) patients in those arms.

“In this randomized clinical trial of patients with paroxysmal AF,” the report concluded, “additional ablation by performing a double ablation lesion set did not result in improved freedom from recurrent AA compared with a standard single ablation set.”

Related: Does Ablation Reduce the Sex Disparity in Atrial Fibrillation?

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