Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA. https://doi.org/10.1001/jama.2024.24438 Dr. Caihua Sang et al.
Points
- The PROMPT-AF trial evaluated whether adding linear ablation and ethanol infusion via the vein of Marshall (EIVOM) to pulmonary vein isolation (PVI) improves rhythm outcomes in patients with persistent atrial fibrillation (AF).
- The multicenter, randomized trial included 498 patients assigned to either PVI alone or PVI combined with EIVOM and linear ablation. The primary outcome was freedom from atrial arrhythmias over 12 months.
- 70.7% of patients in the intervention group (PVI + EIVOM + linear ablation) remained free from atrial arrhythmias without antiarrhythmic drugs, compared to 61.5% in the PVI-only group, demonstrating a statistically significant improvement (P = 0.045).
- Recurrence of atrial arrhythmias and AF burden showed no significant differences between the two groups despite the primary endpoint favoring the combined intervention.
- The findings support the added benefit of combining linear ablation and EIVOM with PVI for maintaining sinus rhythm, offering evidence for optimized ablation strategies in managing persistent AF.
Summary
The PROMPT-AF trial aimed to assess whether the addition of linear ablation combined with ethanol infusion via the vein of Marshall (EIVOM) to pulmonary vein isolation (PVI) improves rhythm outcomes for patients with persistent atrial fibrillation (AF). This multicenter, open-label, randomized trial included 498 patients assigned to either PVI alone or PVI combined with EIVOM and linear ablation. The primary outcome was freedom from documented atrial arrhythmias lasting more than 30 seconds, without using antiarrhythmic drugs, measured over 12 months.
The results revealed that 70.7% of patients in the intervention group (PVI + EIVOM + linear ablation) remained free from atrial arrhythmias without antiarrhythmic drugs, compared with 61.5% in the PVI-only group (hazard ratio, 0.73; 95% CI, 0.54–0.99, P = 0.045). This indicates a statistically significant benefit of combining EIVOM and linear ablation with PVI in improving rhythm outcomes. The effect was consistent across prespecified subgroups, supporting the potential advantages of the combined intervention.
However, secondary outcomes, including atrial arrhythmias and AF burden recurrence, did not show significant differences between the two groups. Despite this, the primary endpoint strongly suggests that adding linear ablation and EIVOM to PVI offers additional benefits in maintaining sinus rhythm in patients with persistent AF. These findings provide crucial clinical evidence for optimizing ablation strategies in this patient population, potentially leading to improved outcomes in managing persistent AF.
Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2826710
References Sang, C., Liu, Q., Lai, Y., Xia, S., Jiang, R., Li, S., Guo, Q., Li, Q., Gao, M., Guo, X., Huang, L., Liu, N., Jiang, C., Zuo, S., Liu, X., Li, M., Ge, W., Song, S., Chen, L., … PROMPT-AF investigators. (2024). Pulmonary vein isolation with optimized linear ablation vs pulmonary vein isolation alone for persistent af: The prompt-af randomized clinical trial. JAMA. https://doi.org/10.1001/jama.2024.24438
