The debate around atrial fibrillation ablation procedures gained clarity last week, when the groundbreaking DECAAF II trial revealed that more aggressive treatment did not lead to better patient outcomes – and even increased health risks for patients with advanced AFib.
The DECAAF II trial, spearheaded by Tulane University researchers, studied 843 AFib patients (44 medical centers, 10 countries) between July 2016 and January 2020, with follow-up through February 2021.
Half of the patients received the standard care, pulmonary vein isolation treatment (PVI), while the other half received MRI-guided atrial fibrosis ablation in addition to the standard PVI. The more aggressive MRI-guided treatment allowed doctors to use a digital 3D map of the patient’s heart to ablate diseased tissue more thoroughly and precisely. Follow-up analysis revealed:
- There was no significant difference in atrial arrhythmia recurrence between the PVI + fibrosis-guided ablation group and PVI alone group (43% vs. 46%; P = 0.63).
- Patients in the fibrosis-guided + PVI group were more likely to experience an adverse event, such as stroke, PV stenosis, bleeding, heart failure, or death (2.2% vs. 0%).
- 1.5% of patients in the fibrosis-guided + PVI group had an ischemic stroke compared to none in the PVI-only group.
- Two deaths occurred in the fibrosis-guided ablation + PVI group (one which may have been procedure-related).
This team of Tulane researchers pushed the field of atrial fibrillation forward last week, finding that MRI-guided atrial fibrosis ablation for treating persistent AF is not superior to conventional catheter ablation. The revelation surprised many cardiologists, underscoring the importance of large, prospective, randomized clinical trials.