Pulmonary vein isolation and low-voltage areas ablation in sinus rhythm for persistent atrial fibrillation (SCAR-AF study)

• DOI: 10.1093/europace/euaf085.096
• Publication Date: 2025-05-23T10:05:04Z
• Authors: A Lepillier; J Pineau; A Otmani; C Durand; X Waintraub; C Zakine; M Niro; G Moubarak; A Zhao; C Bars; N Badenco; W Escande; G Macaluso; O Piot
• Keywords: Isolation

Abstract Background Substrate ablation strategies in addition to pulmonary vein isolation (PVI) for the maintenance of sinus rhythm (SR) are still debated. Targeting low voltage areas (LVA) PVI may represent an efficient strategy persistent atrial fibrillation (AF). Purpose SCAR-AF study (ablation LVA during rhythm) was a multicenter, prospective, randomized trial, evaluating effect AF on SR maintenance. Methods From September 2019 August 2021, patients with de novo were included study. After LA mapping guided by 3D system, divided according presence or absence LVA. Patients without treated only (Group A). B) + C). defined as bipolar <0.5 mV. The primary endpoint freedom from arrhythmias, after single procedure. Results A total 211 (Sex male: 73%, Mean Age 63.8+/-9.3 years, CHADS-VASC 2.1, long standing 33.5%). 18 months FU, atrial-arrhythmia-free survival did not differ significantly between 3 groups, 79% Group A, 75.7% B, 73.1% C vs B: HR: 1.28; 95% CI: 0.64-2.55, p = .48, B C: HR 95%CI: 0.67-2.45; 0.45). Multivariate analysis showed that associated age (years) (HR 1.11 CI 1.06 – 1.16, < 0.001) and inversely correlated BMI (kg/m²) 0.93, 0.87 0.99, 0.029) current smoking. Conclusion In this plus improved outcomes AF. marker severe cardiomyopathy.