4.5 Article

Magnetic Resonance Imaging-Guided Fibrosis Ablation for the Treatment of Atrial Fibrillation The ALICIA Trial

Journal

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCEP.120.008707

Keywords

atrial fibrillation; fibrosis; magnetic resonance imaging; pulmonary veins; treatment outcome

Funding

  1. Instituto de Salud Carlos III, Ministerio de Economia y Competitividad, Spain [PI18/01227, PI16/00435, PI19/00443, PI19/00573]
  2. European Commission [633196]
  3. Agencia de Gestio d'Ajuts Universitaris i de Recerca [2017 SGR 1548]
  4. La MARATO - TV3 [201527]
  5. CIBER Cardiovascular [CB16/11/00403, CB16/11/00354]

Ask authors/readers for more resources

Background: Myocardial fibrosis is key for atrial fibrillation maintenance. We aimed to test the efficacy of ablating cardiac magnetic resonance (CMR)-detected atrial fibrosis plus pulmonary vein isolation (PVI). Methods: This was an open-label, parallel-group, randomized, controlled trial. Patients with symptomatic drug-refractory atrial fibrillation (paroxysmal and persistent) undergoing first or repeat ablation were randomized in a 1:1 basis to receive PVI plus CMR-guided fibrosis ablation (CMR group) or PVI alone (PVI-alone group). The primary end point was the rate of recurrence (>30 seconds) at 12 months of follow-up using a 12-lead ECG and Holter monitoring at 3, 6, and 12 months. The analysis was conducted by intention-to-treat. Results: In total, 155 patients (71% male, age 59 +/- 10, CHA(2)DS(2)-VASc 1.3 +/- 1.1, 54% paroxysmal atrial fibrillation) were allocated to the PVI-alone group (N=76) or CMR group (N=79). First ablation was performed in 80% and 71% of patients in the PVI-alone and CMR groups, respectively. The mean atrial fibrosis burden was 12% (only approximate to 50% of patients had fibrosis outside the pulmonary vein area). One hundred percent and 99% of patients received the assigned intervention in the PVI-alone and CMR group, respectively. The primary outcome was achieved in 21 patients (27.6%) in the PVI-alone group and 22 patients (27.8%) in the CMR group (odds ratio: 1.01 [95% CI, 0.50-2.04]; P=0.976). There were no differences in the rate of adverse events (3 in the CMR group and 2 in the PVI-alone group; P=0.68). Conclusions: A pragmatic ablation approach targeting CMR-detected atrial fibrosis plus PVI was not more effective than PVI alone in an unselected population undergoing atrial fibrillation ablation with low fibrosis burden. Registration: URL: . Unique identifier: NCT02698631.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.5
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available