Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial

Sunaga, Akihiro; Matsuoka, Yuki; Nakatani, Daisaku; Okada, Katsuki; 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; Hikoso, Shungo; Sotomi, Yohei; Sakata, Yasushi

doi:https://doi.org/10.1016/j.ijcard.2024.132231

Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial

Sunaga, Akihiro; Matsuoka, Yuki; Nakatani, Daisaku et al.

International Journal of Cardiology, 2024, 410, 132231

Number of Access:96（2025-04-30 15:36 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/97651

Link to primary information

File	Format	Terms of use	Size	Views	Date.Available	Description	information
IntJCardiol_410_132231	pdf	None	1.05 MB	51	2024.08.06

Creative Commons : Attribution

Item Information

Output File Export EndNote Basic Export Mendeley

Title	Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial
Creator	NRID 1000010812258 1000010812258 researchmap permalink 10812258 10812258 CreatorName Sunaga, Akihiro
	CreatorName Matsuoka, Yuki
	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
	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
	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 1000030423164 1000030423164 researchmap permalink hikoso_osakauniv hikoso_osakauniv CreatorName Hikoso, Shungo
	NRID 1000090885253 1000090885253 ORCID 0000-0002-7564-2978 0000-0002-7564-2978 researchmap permalink sotomiyohei sotomiyohei CreatorName Sotomi, Yohei
	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	Atrial fibrillation
	CFAE ablation
	Linear ablation
	Mitral regurgitation
	Recurrence
Description	Sunaga A., Matsuoka Y., Nakatani D., et al. Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial. International Journal of Cardiology 410, 132231 (2024); https://doi.org/10.1016/j.ijcard.2024.132231.
Abstract	Background: Extensive ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not yielded consistent results, indicating diversity in their efficacy. Mitral regurgitation (MR) associated with AF may indicate a higher prevalence of arrhythmogenic substrate, suggesting potential benefits of extensive ablation for these patients. Methods: This post-hoc analysis of the EARNEST-PVI trial compared PVI alone versus an extensive ablation strategy (PVI-plus) in persistent AF patients, stratified by MR presence. The primary endpoint of the study was the recurrence of AF. The secondary endpoints included death, cerebral infarction, and procedure-related complications. Results: The trial included 495 eligible patients divided into MR and non-MR groups. The MR group consisted of 192 patients (89 in the PVI-alone arm and 103 in the PVI-plus arm), while the non-MR group had 303 patients (158 in the PVI-alone arm and 145 in the PVI-plus arm). In the non-MR group, recurrence rates were similar between PVI-alone and PVI-plus arms (Log-rank P = 0.47, Hazard ratio = 0.85 [95%CI: 0.54–1.33], P = 0.472). However, in the MR group, PVI-plus was significantly more effective in preventing AF recurrence (Log-rank P = 0.0014, Hazard ratio = 0.40 [95%CI: 0.22–0.72], P = 0.0021). No significant differences were observed in secondary endpoints between the two arms. Conclusions: For persistent AF patients with mild or greater MR, receiving PVI-plus was superior to PVI-alone in preventing AF recurrence. Conversely, for patients without MR, the effectiveness of extensive ablation was not demonstrated. These findings suggest tailoring ablation strategies based on MR presence can lead to better outcomes in AF management.
Publisher	Elsevier Ireland Ltd
Source Title	International Journal of Cardiology
Volume (Issue)	410
Page	132231
Date of Issued	2024-09-01
Language	English
Handle URL	https://hdl.handle.net/11094/97651
PISSN	01675273
eISSN	18741754
Relation.isIdenticalTo	DOI (Publisher Version) https://doi.org/10.1016/j.ijcard.2024.132231
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
DCTERMS.bibliographicCitation	International Journal of Cardiology. 2024, 410, p. 132231
DC.title	Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial
DC.creator	Sunaga, Akihiro
	Matsuoka, Yuki
	Nakatani, Daisaku
	Okada, Katsuki
	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
	Hikoso, Shungo
	Sotomi, Yohei
	Sakata, Yasushi
DC.publisher	Elsevier Ireland Ltd
DC.language' scheme='DCTERMS.RFC1766	English
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2024-09-01
DC.identifier	https://doi.org/10.1016/j.ijcard.2024.132231
DC.subject	Atrial fibrillation
	CFAE ablation
	Linear ablation
	Mitral regurgitation
	Recurrence
DC.description	Sunaga A., Matsuoka Y., Nakatani D., et al. Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial. International Journal of Cardiology 410, 132231 (2024); https://doi.org/10.1016/j.ijcard.2024.132231.
DCTERMS.abstract	Background: Extensive ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not yielded consistent results, indicating diversity in their efficacy. Mitral regurgitation (MR) associated with AF may indicate a higher prevalence of arrhythmogenic substrate, suggesting potential benefits of extensive ablation for these patients. Methods: This post-hoc analysis of the EARNEST-PVI trial compared PVI alone versus an extensive ablation strategy (PVI-plus) in persistent AF patients, stratified by MR presence. The primary endpoint of the study was the recurrence of AF. The secondary endpoints included death, cerebral infarction, and procedure-related complications. Results: The trial included 495 eligible patients divided into MR and non-MR groups. The MR group consisted of 192 patients (89 in the PVI-alone arm and 103 in the PVI-plus arm), while the non-MR group had 303 patients (158 in the PVI-alone arm and 145 in the PVI-plus arm). In the non-MR group, recurrence rates were similar between PVI-alone and PVI-plus arms (Log-rank P = 0.47, Hazard ratio = 0.85 [95%CI: 0.54–1.33], P = 0.472). However, in the MR group, PVI-plus was significantly more effective in preventing AF recurrence (Log-rank P = 0.0014, Hazard ratio = 0.40 [95%CI: 0.22–0.72], P = 0.0021). No significant differences were observed in secondary endpoints between the two arms. Conclusions: For persistent AF patients with mild or greater MR, receiving PVI-plus was superior to PVI-alone in preventing AF recurrence. Conversely, for patients without MR, the effectiveness of extensive ablation was not demonstrated. These findings suggest tailoring ablation strategies based on MR presence can lead to better outcomes in AF management.
DC.rights	This article is licensed under a Creative Commons Attribution 4.0 International License.
DC.format	97651
citation_title	Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial
citation_author	Sunaga, Akihiro
	Matsuoka, Yuki
	Nakatani, Daisaku
	Okada, Katsuki
	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
	Hikoso, Shungo
	Sotomi, Yohei
	Sakata, Yasushi
citation_publisher	Elsevier Ireland Ltd
citation_language	English
citation_date	2024-09-01
citation_journal_title	International Journal of Cardiology
citation_volume	410
citation_firstpage	132231
citation_doi	https://doi.org/10.1016/j.ijcard.2024.132231
citation_public_url	https://hdl.handle.net/11094/97651

Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial

Link to primary information

Item Information

Show details