Voltage-Guided PVI Matches Conventional Methods in Efficacy and Slashes Procedure Time for AF Treatment: Study

Atrial fibrillation, a common cardiac arrhythmia, affects millions worldwide and can lead to severe complications such as stroke and heart failure. The standard treatment for this condition has been catheter ablation, which involves isolating the pulmonary veins to prevent abnormal electrical signals that cause AF. Traditionally, this procedure has been guided by LSI, which maps the electrical activity of the heart to create precise lesions around the pulmonary veins.

However, voltage-guided PVI has emerged as a promising alternative. Unlike LSI-guided methods that focus on creating a specific set of lesions based on electrical activity, voltage-guided PVI utilizes the voltage signals in the heart to direct the ablation process. This technique relies on detecting low-voltage areas that indicate diseased tissue, allowing for targeted ablation of the pulmonary veins.

Against the above background, Jun Kishihara, Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan, and colleagues aimed to investigate whether voltage-guided PVI is noninferior to conventional LSI-guided PVI in patients with nonvalvular AF.

For this purpose, the researchers conducted a multicenter randomized trial over 12 months. The study’s primary efficacy endpoints included recurrence of atrial fibrillation, atrial flutter, and/or atrial tachycardia, with a noninferiority margin established at a hazard ratio of 1.4. For assessing safety, the main endpoint was a composite measure of complications related to the procedure.

The study led to the following findings:

• A total of 370 patients underwent randomization; 189 and 181 were assigned to the voltage (underwent voltage-guided PVI) and control (underwent conventional LSI-guided PVI) groups, respectively.
• The primary efficacy endpoint occurred in 12.0% of patients in the voltage group and 12.9% in the control group (1-year Kaplan–Meier event-free rate estimates, 88.0%, and 87.1%, respectively; hazard ratio, 1.00).
• The primary safety endpoints were 4.8% in the voltage group and 6.6% in the control group.
• PVI time was significantly shorter in the voltage group (35.7 ± 14.5 min versus 39.7 ± 14.7 min).

“Based on the findings, we found voltage-guided PVI to be noninferior to conventional LSI-guided PVI for efficacy in the treatment of patients with AF, and its use significantly reduced procedure time,” the researchers concluded.

Reference:

Kishihara, J., Fukaya, H., Yamashita, K., Ono, M., Igawa, W., Saito, J., Takano, M., Ishizue, N., Nakamura, H., Matsuura, G., & Oikawa, J. (2024). Voltage-guided Pulmonary Vein Isolation for Atrial Fibrillation. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2024.08.041