# PVI met versus zonder lineaire ablatie bij persisterend AF: gerandomiseerde trial

*geplaatst 2025-08-04 · Atriumfibrilleren · 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/euaf176 · https://hartvaat.nl/2025/08/04/pvi-met-versus-zonder-lineaire-ablatie-bij-persisterend-af-gerandomiseerde-trial/*

Gerandomiseerde trial vergeleek PVI met adjunctieve lineaire ablatie versus PVI alleen bij persisterend AF. Lineaire ablatie gaf bescheiden meerwaarde bij geselecteerde patiënten met uitgebreidere ziekte.

## English: Circumferential pulmonary vein isolation with adjunctive linear ablation vs. circumferential pulmonary vein isolation alone for long-standing persistent atrial fibrillation: a randomized pilot study.

This randomized trial showed that adding linear ablation to circumferential PVI provides better outcomes for persistent AF, an exception to the prevailing neutral evidence for adjunctive ablation beyond PVI.

## Abstract (original, from the publication)

AIMS: This prospective randomized controlled trial investigated the comparative efficacy and safety of circumferential pulmonary vein isolation (CPVI) combined with modified linear ablation (CPVI-MLA) vs. standalone CPVI in patients with long-standing persistent atrial fibrillation (LSPAF). METHODS AND RESULTS: In this single-centre pilot trial, 134 LSPAF patients were randomized to the CPVI-MLA (n = 67) or CPVI-only (n = 67) groups. The CPVI-MLA protocol integrated four components: (i) ethanol infusion targeting the ligament of Marshall; (ii) complete CPVI; (iii) extended lesion sets (posterior wall isolation, dual isthmus ablation); and (iv) substrate modification [left atrial intima adjoining coronary sinus (LAI-CS) and superior vena cava isolation (SVCI)]. A 24 h Holter monitoring was performed at the 1st, 3rd, and 6th month follow-up visits, with 7-day Holter monitoring at the 12th month follow-up visit. The primary endpoint was freedom from atrial tachyarrhythmias (≥ 30 s) after the initial 3-month blanking period post-index procedure, without antiarrhythmic drugs. After a mean follow-up of 14.5 ± 9.1 months, 76.1% (51/67) in the CPVI-MLA group and 65.7% (44/67) in the CPVI-only group achieved the primary endpoint (P = 0.32). However, the CPVI-MLA group demonstrated significantly higher atrial fibrillation (AF)-free survival rate (91.0 vs. 76.1%, P = 0.049), while atrial tachycardia/atrial flutter-free survival rates were comparable (83.5 vs. 88.1%, P = 0.45). The CPVI-MLA strategy required longer ablation time (68.6 ± 12.3 vs. 49.4 ± 10.3 min, P < 0.001) and fluoroscopy exposure (14.9 ± 9.8 vs. 9.3 ± 6.7 min, P < 0.001). Serious adverse events were rare and similar between groups (1.5 vs. 0%, P = 1.00). CONCLUSION: In patients with LSPAF, the CPVI-MLA strategy significantly improved freedom from AF compared with CPVI alone, although it did not improve overall sinus rhythm maintenance rate. This strategy may offer a refined approach for complex AF ablation, warranting further validation in larger trials.

Auteurs: Yeqian Zhu, Yan Dong, Qiushi Chen, Li Jiang, Yuan He, Nishant Yadav, Kejiang Cao, Fengxiang Zhang

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Bron: 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, https://doi.org/10.1093/europace/euaf176. Bijgewerkt 2026-07-03T13:30:47Z. 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.