{"id":"e11a2c7e05bc","type":"article","url":"https://hartvaat.nl/2023/05/19/drie-substraatstrategieen-voor-persisterend-af-vergeleken-multicenter-rct/","title":"Drie substraatstrategieën voor persisterend AF vergeleken: multicenter RCT","title_en":"Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euad090","source_url":"https://doi.org/10.1093/europace/euad090","authors":["Kaige Li","Changhao Xu","Xiyao Zhu","Xinhua Wang","Ping Ye","Weifeng Jiang","Shaohui Wu","Kai Xu","Xiangting Li","Ying Wang","Qidong Zheng","Yanzhe Wang","Lihua Leng","Zengtang Zhang","Bing Han","Yu Zhang","Mu Qin","Xu Liu"],"significance":6,"published":"2023-05-19","source_date":"2023-05-19","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This multicenter RCT compared three substrate ablation strategies for persistent AF, finding that no additional strategy (empirical linear lesions or voltage-guided ablation) significantly improved outcomes over PVI plus empirical lines.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T13:29:27Z","licence":"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.","body_markdown":"Multicenter RCT vergeleek drie ablatiestategieën bij persisterend AF. PVI plus empirische lineaire ablatie, PVI plus voltage-geleide ablatie en uitgebreide PVI gaven vergelijkbare recidiefpercentages. De optimale substraatstrategie blijft onduidelijk.","abstract_original":"AIMS: The optimal strategy for persistent atrial fibrillation (PerAF) is poorly defined. We conducted a multicentre, randomized, prospective trial to compare the outcomes of different ablation strategies for PerAF. METHODS AND RESULTS: We enrolled 450 patients and randomly assigned them in a 1:1:1 ratio to undergo pulmonary vein isolation and subsequently undergo the following three different ablation strategies: anatomical guided ablation (ANAT group, n = 150), electrogram guided ablation (EGM group, n = 150), and extensive electro-anatomical guided ablation (EXT group, n = 150). The primary endpoint was freedom from atrial fibrillation (AF) lasting longer than 30 s at 12 months after a single ablation procedure. After 12 months of follow-up, 72% (108) of patients in the EXT group were free from AF recurrence, as compared with the 64% (96) in the EGM group (P = 0.116), and 54% (81) in the ANAT group (P = 0.002). The EXT group showed less AF/atrial tachycardia recurrence than the EGM group (60% vs. 50%, P = 0.064) and the ANAT group (60% vs. 37.3%, P < 0.001). The EXT group showed the highest rate of AF termination (66.7%), followed by 56.7% in the EGM group, and 20.7% in the ANAT group. The AF termination signified less AF recurrence at 12 months compared to patients without AF termination (30.1% vs. 42.7%, P = 0.008). Safety endpoints did not differ significantly between the three groups (P = 0.924). CONCLUSIONS: Electro-anatomical guided ablation achieved the most favourable outcomes among the three ablation strategies. The AF termination is a reliable ablation endpoint."}