Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial

Matsuoka, Yuki; Sotomi, Yohei; Hikoso, Shungo; Sunaga, Akihiro; Nakatani, Daisaku; Okada, Katsuki; Dohi, Tomoharu; Sato, Taiki; Kida, Hirota; Sakamoto, Daisuke; Kitamura, Tetsuhisa; Tanaka, Nobuaki; Masuda, Masaharu; Watanabe, Tetsuya; Minamiguchi, Hitoshi; Egami, Yasuyuki; Oka, Takafumi; Miyoshi, Miwa; Okada, Masato; Matsuda, Yasuhiro; Kawasaki, Masato; Inoue, Koichi; Sakata, Yasushi

doi:https://doi.org/10.1016/j.jjcc.2024.09.001

Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial

Matsuoka, Yuki; Sotomi, Yohei; Hikoso, Shungo et al.

Journal of Cardiology, 2025, 85(4), 301-308

Number of Access:20（2025-04-30 13:08 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/101079

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Title	Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial
Creator	CreatorName Matsuoka, Yuki
	NRID 1000090885253 1000090885253 ORCID 0000-0002-7564-2978 0000-0002-7564-2978 researchmap permalink sotomiyohei sotomiyohei CreatorName Sotomi, Yohei
	NRID 1000030423164 1000030423164 researchmap permalink hikoso_osakauniv hikoso_osakauniv CreatorName Hikoso, Shungo
	NRID 1000010812258 1000010812258 researchmap permalink 10812258 10812258 CreatorName Sunaga, Akihiro
	NRID 1000060444535 1000060444535 researchmap permalink dsyma dsyma Scopus Author ID 6603545219 6603545219 CreatorName Nakatani, Daisaku
	NRID 1000020776489 1000020776489 researchmap permalink katsuki_okada katsuki_okada Scopus Author ID 13613369100 13613369100 CreatorName Okada, Katsuki
	NRID 1000090838137 1000090838137 researchmap permalink dohi_1230 dohi_1230 Scopus Author ID 35071263000 35071263000 CreatorName Dohi, Tomoharu
	CreatorName Sato, Taiki
	CreatorName Kida, Hirota
	CreatorName Sakamoto, Daisuke
	NRID 1000030639810 1000030639810 ORCID 0000-0003-0107-0580 0000-0003-0107-0580 researchmap permalink Kitamura_T Kitamura_T Scopus Author ID 22234282700 22234282700 CreatorName Kitamura, Tetsuhisa
	CreatorName Tanaka, Nobuaki
	CreatorName Masuda, Masaharu
	CreatorName Watanabe, Tetsuya
	NRID 1000090648495 1000090648495 CreatorName Minamiguchi, Hitoshi
	CreatorName Egami, Yasuyuki
	NRID 1000030647285 1000030647285 researchmap permalink Takafumioka0410 Takafumioka0410 Scopus Author ID 8712739400 8712739400 CreatorName Oka, Takafumi
	CreatorName Miyoshi, Miwa
	CreatorName Okada, Masato
	CreatorName Matsuda, Yasuhiro
	CreatorName Kawasaki, Masato
	CreatorName Inoue, Koichi
	NRID 1000000397671 1000000397671 ORCID 0000-0002-5618-4721 0000-0002-5618-4721 researchmap permalink C4589 C4589 Scopus Author ID 35395964700 35395964700 CreatorName Sakata, Yasushi
Subject	Catheter ablation
	Elderly
	Persistent atrial fibrillation
	Stratification
Description	Matsuoka Y., Sotomi Y., Hikoso S., et al. Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial. Journal of Cardiology 85, 301 (2025); https://doi.org/10.1016/j.jjcc.2024.09.001.
Abstract	Background: In patients with persistent atrial fibrillation (AF), extensive ablation for substrate modification, such as linear ablation or complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation (PVI) remains controversial. Previous studies investigating extensive ablation have demonstrated its varying efficacy, suggesting the possible heterogeneity of its efficacy. Aging is a major risk factor for AF and is associated with atrial remodeling. We aimed to compare the efficacy and safety of the extensive ablation strategy compared with PVI alone strategy between young and elderly patients. Methods: This study is a post-hoc analysis of the multicenter, randomized controlled, noninferiority trial investigating the efficacy and safety of PVI-only (PVI-alone arm) compared with extensive ablation (PVI-plus arm) in patients with persistent AF (EARNEST-PVI trial). We divided the overall population into 2 groups based on age and assessed treatment effects. Results: In the young group (age <65 years, N = 206), there was no significant difference in the recurrence rate between the PVI-alone group and PVI-plus group [hazard ratio (HR): 1.00, 95 % CI: 0.57–1.73, p = 0.987], whereas the recurrence rate was significantly lower in the PVI-plus group compared to the PVI-alone group in the elderly group (age ≥65 years, N = 291) (HR: 0.47, 95 % CI: 0.29–0.76, p = 0.0021) (p for interaction = 0.0446). There were no fatal procedural complications. Conclusion: In patients with persistent AF, the extensive ablation strategy was more effective than the PVI-alone strategy in elderly patients, while the effectiveness of both approaches was comparable in young patients. Trial registration: URL: https://clinicaltrials.gov; Unique identifier: NCT03514693. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022454 Unique ID issued by UMIN: UMIN000019449.
Publisher	Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Source Title	Journal of Cardiology
Volume (Issue)	85(4)
Page	301-308
Date of Issued	2025-04
Language	English
Handle URL	https://hdl.handle.net/11094/101079
PISSN	09145087
eISSN	18764738
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1016/j.jjcc.2024.09.001
Access Rights	open access
CopyRight	This article is licensed under a Creative Commons Attribution 4.0 International License.
oaire:version	Version of Record
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCMI Type	Text
DCTERMS.bibliographicCitation	Journal of Cardiology. 2025, 85(4), p. 301-308
DC.title	Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial
DC.creator	Matsuoka, Yuki
	Sotomi, Yohei
	Hikoso, Shungo
	Sunaga, Akihiro
	Nakatani, Daisaku
	Okada, Katsuki
	Dohi, Tomoharu
	Sato, Taiki
	Kida, Hirota
	Sakamoto, Daisuke
	Kitamura, Tetsuhisa
	Tanaka, Nobuaki
	Masuda, Masaharu
	Watanabe, Tetsuya
	Minamiguchi, Hitoshi
	Egami, Yasuyuki
	Oka, Takafumi
	Miyoshi, Miwa
	Okada, Masato
	Matsuda, Yasuhiro
	Kawasaki, Masato
	Inoue, Koichi
	Sakata, Yasushi
DC.publisher	Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
DC.language' scheme='DCTERMS.RFC1766	English
DC.type' scheme='DCTERMS.DCMIType	Text
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2025-04
DC.identifier	https://doi.org/10.1016/j.jjcc.2024.09.001
DC.subject	Catheter ablation
	Elderly
	Persistent atrial fibrillation
	Stratification
DC.description	Matsuoka Y., Sotomi Y., Hikoso S., et al. Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial. Journal of Cardiology 85, 301 (2025); https://doi.org/10.1016/j.jjcc.2024.09.001.
DCTERMS.abstract	Background: In patients with persistent atrial fibrillation (AF), extensive ablation for substrate modification, such as linear ablation or complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation (PVI) remains controversial. Previous studies investigating extensive ablation have demonstrated its varying efficacy, suggesting the possible heterogeneity of its efficacy. Aging is a major risk factor for AF and is associated with atrial remodeling. We aimed to compare the efficacy and safety of the extensive ablation strategy compared with PVI alone strategy between young and elderly patients. Methods: This study is a post-hoc analysis of the multicenter, randomized controlled, noninferiority trial investigating the efficacy and safety of PVI-only (PVI-alone arm) compared with extensive ablation (PVI-plus arm) in patients with persistent AF (EARNEST-PVI trial). We divided the overall population into 2 groups based on age and assessed treatment effects. Results: In the young group (age <65 years, N = 206), there was no significant difference in the recurrence rate between the PVI-alone group and PVI-plus group [hazard ratio (HR): 1.00, 95 % CI: 0.57–1.73, p = 0.987], whereas the recurrence rate was significantly lower in the PVI-plus group compared to the PVI-alone group in the elderly group (age ≥65 years, N = 291) (HR: 0.47, 95 % CI: 0.29–0.76, p = 0.0021) (p for interaction = 0.0446). There were no fatal procedural complications. Conclusion: In patients with persistent AF, the extensive ablation strategy was more effective than the PVI-alone strategy in elderly patients, while the effectiveness of both approaches was comparable in young patients. Trial registration: URL: https://clinicaltrials.gov; Unique identifier: NCT03514693. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022454 Unique ID issued by UMIN: UMIN000019449.
DC.rights	This article is licensed under a Creative Commons Attribution 4.0 International License.
DC.format	101079
citation_title	Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial
citation_author	Matsuoka, Yuki
	Sotomi, Yohei
	Hikoso, Shungo
	Sunaga, Akihiro
	Nakatani, Daisaku
	Okada, Katsuki
	Dohi, Tomoharu
	Sato, Taiki
	Kida, Hirota
	Sakamoto, Daisuke
	Kitamura, Tetsuhisa
	Tanaka, Nobuaki
	Masuda, Masaharu
	Watanabe, Tetsuya
	Minamiguchi, Hitoshi
	Egami, Yasuyuki
	Oka, Takafumi
	Miyoshi, Miwa
	Okada, Masato
	Matsuda, Yasuhiro
	Kawasaki, Masato
	Inoue, Koichi
	Sakata, Yasushi
citation_publisher	Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
citation_language	English
citation_date	2025-04
citation_journal_title	Journal of Cardiology
citation_volume	85
citation_issue	4
citation_firstpage	301
citation_lastpage	308
citation_doi	https://doi.org/10.1016/j.jjcc.2024.09.001
citation_public_url	https://hdl.handle.net/11094/101079

Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial

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