Radiofrequency catheter ablation of persistent atrial fibrillation by pulmonary vein isolation with or without left atrial posterior wall isolation: long-term outcomes of the CAPLA trial
Bibliographic record
Abstract
BACKGROUND AND AIMS: Posterior wall isolation (PWI) is commonly incorporated into catheter ablation (CA) strategies for persistent atrial fibrillation (AF) in an attempt to improve outcomes. In the CAPLA randomized study, adjunctive PWI did not improve freedom from atrial arrhythmia at 12 months compared with pulmonary vein isolation (PVI) alone. Whether additional PWI reduces arrhythmia recurrence over the longer term remains unknown. METHODS: In this multi-centre, international, randomized study patients with persistent AF undergoing index CA using radiofrequency were randomized to PVI + PWI vs. PVI alone. Patients underwent regular follow-up including rhythm monitoring for a minimum of 3 years after CA. Atrial fibrillation burden at 3 years after ablation was evaluated with either 28-day continuous ambulatory electrocardiogram (ECG) monitoring, twice daily single-lead ECG or from cardiac implanted device. Evaluated endpoints included freedom from any documented atrial arrhythmia recurrence after a single procedure, AF burden, need for redo CA, rhythm at last clinical follow-up, healthcare utilization metrics, and AF-related quality of life. RESULTS: Three hundred thirty-three of 338 (98.5%) patients (mean age 64.3 ± 9.4 years, 23% female) completed 3-year follow-up, with 169 patients randomized to PVI + PWI and 164 patients to PVI alone. At a median of 3.62 years after index ablation, freedom from recurrent atrial arrhythmia occurred in 59 patients (35.5%) randomized to PVI + PWI vs. 68 patients (42.1%) randomized to PVI alone (hazard ratio 1.15, 95% confidence interval 0.88-1.51, P = .55). Median time to recurrent atrial arrhythmia was 0.53 years (interquartile range 0.34-1.01 years). Redo ablation was performed in 54 patients (32.0%) in the PVI + PWI group vs. 49 patients (29.9%, P = .68) in the PVI alone group. Pulmonary vein reconnection was present in 54.5% (mean number of reconnected PVs 2.2 ± .9) and posterior wall reconnection in 75%. Median AF burden at 3 years was 0% in both groups (interquartile range 0%-0.85% PVI + PWI vs. 0%-1.43% PVI alone, P = .49). Sinus rhythm at final clinical follow-up was present in 85.1% with PVI + PWI vs. 87.1% with PVI alone (P = .60). Mean AF Effect On Quality-Of-Life (AFEQT) score at 3 years after ablation was 88.0 ± 14.8 with PVI + PWI vs. 88.9 ± 15.4 with PVI alone (P = .63). CONCLUSIONS: In patients with persistent AF, the addition of PWI to PVI alone at index radiofrequency CA did not significantly improve freedom from atrial arrhythmia recurrence at long-term follow-up. Median AF burden remains low and AF quality of life high at 3 years with either ablation strategy.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".