AI-Guided Catheter Ablation Proves Superior to Standard Pulmonary Vein Isolation for Persistent AF
A multicenter, double-blind, randomized trial demonstrated that AI-guided ablation targeting spatio-temporal electrogram dispersion areas in addition to pulmonary vein isolation was superior to PVI alone for eliminating persistent atrial fibrillation at one year (88% vs 70% freedom from AF). Procedure and ablation times were approximately twice as long in the tailored arm, though safety profiles were comparable. The results establish AI-driven electrogram analysis as a viable approach for personalizing ablation strategy in drug-refractory persistent AF.
The original study
Artificial intelligence for individualized treatment of persistent atrial fibrillation: a randomized controlled trial.
- Authors
- Deisenhofer I, Albenque JP, Busch S, Gitenay E, Mountantonakis SE, Roux A, et al.
- Journal
- Nature medicine
- Type
- Journal Article, Randomized Controlled Trial, Multicenter Study, Equivalence Trial
- PMID
- 39953289
Original abstract
Although pulmonary vein isolation (PVI) has become the cornerstone ablation procedure for atrial fibrillation (AF), the optimal ablation procedure for persistent and long-standing persistent AF remains elusive. Targeting spatio-temporal electrogram dispersion in a tailored procedure has been suggested as a potentially beneficial alternative to a conventional PVI-only procedure. In this multicenter, randomized, controlled, double-blind, superiority trial, patients with drug-refractory persistent AF were randomly assigned to a tailored ablation procedure targeting areas of spatio-temporal dispersion, as detected by an artificial intelligence (AI) algorithm, in addition to PVI (tailored arm, n = 187, 23% women) or to a conventional PVI-only procedure (anatomical arm, n = 183, 19% women). The primary efficacy endpoint was freedom from documented AF with or without antiarrhythmic drugs at 12 months after a single ablation procedure. Secondary endpoints included freedom from any atrial arrhythmic events, and the secondary composite safety endpoint consisted of death, cerebrovascular events, or treatment-related serious adverse events. One year post-procedure, the trial met its primary efficacy endpoint, which was achieved in 88% of patients in the tailored arm compared with 70% of patients in the anatomical arm (log-rank P < 0.0001 for superiority). However, no significant difference between arms was observed for the freedom from any atrial arrhythmia endpoint after one ablation. The safety endpoint did not differ between arms, with procedure and ablation times being twice as long in the tailored arm. These results show that AI-guided ablation of spatio-temporal dispersion areas in addition to PVI is superior to PVI alone in eliminating AF at 1-year follow-up in patients with persistent and long-standing persistent AF. Ablation of subsequent organized atrial tachycardias may be needed to maintain sinus rhythm long term. ClinicalTrials.gov identifier: NCT04702451 .