# MRI-geleide fibroseablatie versus conventionele ablatie bij persisterend AF

*geplaatst 2022-06-21 · Atriumfibrilleren · JAMA · doi 10.1001/jama.2022.8831 · https://hartvaat.nl/2022/06/21/mri-geleide-fibroseablatie-versus-conventionele-ablatie-bij-persisterend-af/*

De DECAAF II-trial vergeleek MRI-geleide fibroseablatie met conventionele catheterablatie bij persisterend AF. MRI-geleide ablatie liet geen significant voordeel zien in AF-recidief. Pulmonaalvenenisolatie blijft de hoeksteen, en aanvullende fibroseablatie verbeterde de uitkomst niet.

## English: Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial.

The DECAAF II trial showed that MRI-guided fibrosis ablation did not improve freedom from atrial arrhythmia compared with conventional catheter ablation in patients with persistent AF. The negative result suggested that current MRI-based fibrosis mapping does not reliably guide ablation targets.

## Abstract (original, from the publication)

IMPORTANCE: Ablation of persistent atrial fibrillation (AF) remains a challenge. Left atrial fibrosis plays an important role in the pathophysiology of AF and has been associated with poor procedural outcomes. OBJECTIVE: To investigate the efficacy and adverse events of targeting atrial fibrosis detected on magnetic resonance imaging (MRI) in reducing atrial arrhythmia recurrence in persistent AF. DESIGN, SETTING, AND PARTICIPANTS: The Efficacy of Delayed Enhancement-MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation of Atrial Fibrillation trial was an investigator-initiated, multicenter, randomized clinical trial involving 44 academic and nonacademic centers in 10 countries. A total of 843 patients with symptomatic or asymptomatic persistent AF and undergoing AF ablation were enrolled from July 2016 to January 2020, with follow-up through February 19, 2021. INTERVENTIONS: Patients with persistent AF were randomly assigned to pulmonary vein isolation (PVI) plus MRI-guided atrial fibrosis ablation (421 patients) or PVI alone (422 patients). Delayed-enhancement MRI was performed in both groups before the ablation procedure to assess baseline atrial fibrosis and at 3 months postablation to assess for ablation scar. MAIN OUTCOMES AND MEASURES: The primary end point was time to first atrial arrhythmia recurrence after a 90-day blanking period postablation. The primary safety composite outcome was defined by the occurrence of 1 or more of the following events within 30 days postablation: stroke, PV stenosis, bleeding, heart failure, or death. RESULTS: Among 843 patients who were randomized (mean age 62.7 years; 178 [21.1%] women), 815 (96.9%) completed the 90-day blanking period and contributed to the efficacy analyses. There was no significant difference in atrial arrhythmia recurrence between groups (fibrosis-guided ablation plus PVI patients, 175 [43.0%] vs PVI-only patients, 188 [46.1%]; hazard ratio [HR], 0.95 [95% CI, 0.77-1.17]; P = .63). Patients in the fibrosis-guided ablation plus PVI group experienced a higher rate of safety outcomes (9 [2.2%] vs 0 in PVI group; P = .001). Six patients (1.5%) in the fibrosis-guided ablation plus PVI group had an ischemic stroke compared with none in PVI-only group. Two deaths occurred in the fibrosis-guided ablation plus PVI group, and the first one was possibly related to the procedure. CONCLUSIONS AND RELEVANCE: Among patients with persistent AF, MRI-guided fibrosis ablation plus PVI, compared with PVI catheter ablation only, resulted in no significant difference in atrial arrhythmia recurrence. Findings do not support the use of MRI-guided fibrosis ablation for the treatment of persistent AF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02529319.

Auteurs: Nassir F Marrouche, Oussama Wazni, Christopher McGann, Tom Greene, J Michael Dean, Lilas Dagher, Eugene Kholmovski, Moussa Mansour, Francis Marchlinski, David Wilber, Gerhard Hindricks, Christian Mahnkopf, Darryl Wells, Pierre Jais, Prashanthan Sanders, Johannes Brachmann, Jeroen J Bax, Leonie Morrison-de Boer, Thomas Deneke, Hugh Calkins, Christian Sohns, Nazem Akoum

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Bron: JAMA, https://doi.org/10.1001/jama.2022.8831. Bijgewerkt 2026-07-03T13:28:55Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.