- Question
- Does adding posterior left atrial wall isolation to pulmonary vein isolation using pulsed field ablation reduce atrial tachyarrhythmia recurrence in patients with symptomatic persistent atrial fibrillation?
- Design
- Investigator-initiated, multicenter, randomized 1:1 superiority trial with blinded end-point adjudication, conducted at 6 centers in Switzerland and enrolling 206 patients. All patients received an implantable cardiac monitor after ablation and were followed for 1 year.
- Population
- Patients with symptomatic persistent atrial fibrillation (mean age 65.8 years; 80.1% male).
- Intervention
- Pulmonary vein isolation using pulsed field ablation plus posterior left atrial wall isolation (102 patients).
- Control
- Pulmonary vein isolation using pulsed field ablation alone (104 patients).
- Primary outcome
- First recurrence of atrial tachyarrhythmia during days 91 to 365 after ablation, detected by continuous implantable monitor recording and adjudicated by an independent committee blinded to treatment allocation.
- Results
- Atrial tachyarrhythmia recurred in 51 of 102 patients (50.6%) with posterior wall isolation and in 63 of 104 (60.6%) with pulmonary vein isolation alone (rate ratio 0.75; 95% CI 0.51-1.09; P = .13). Mean atrial arrhythmia burden was 6.9% vs 11.0% (difference −4.1 percentage points; 95% CI −8.0 to −0.2; P = .04).
- Safety
- The safety composite (tamponade, persistent phrenic nerve palsy, serious vascular complications, stroke/TIA, atrioesophageal fistula, or death through day 90) occurred in 2 patients in the posterior wall isolation group.
- Conclusion
- In persistent atrial fibrillation, adding pulsed field posterior wall isolation did not significantly reduce atrial tachyarrhythmia recurrence compared with pulmonary vein isolation alone; secondary findings are hypothesis generating.
- Why it matters
- The trial does not support routine additional posterior wall ablation with pulsed field energy in persistent atrial fibrillation, although signals in secondary end points warrant testing in a larger trial.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026