Letter from the Editor in Chief

DOI: 10.19102/icrm.2020.110607

MOUSSA MANSOUR, MD, FHRS, FACC

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Dr. Mansour reports the reception of research grants from Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Medtronic, Pfizer, Boehringer Ingelheim, and SentreHeart. He is also a consultant for Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Janssen, Medtronic, Phillips, Novartis, and SentreHeart and reports an equity relationship with EPS Solutions. All aforementioned relationships are in the area of atrial fibrillation; Dr. Mansour additionally reports an equity relationship in the area of ventricular fibrillation with NewPace Ltd.

Dear Readers,

Among the landmark clinical trials presented last month during the HRS 2020 Science online broadcast was the Review of the Safety and Effectiveness of the THERMOCOOL SMARTTOUCH^® SF Catheter Evaluated for Treating Symptomatic Persistent Atrial Fibrillation (PRECEPT) trial.¹ In this prospective, multicenter study, 348 patients across 27 centers in the United States and Canada underwent pulmonary vein (PV) isolation (PVI) alone (55.5%) or PVI plus additional ablation targets (mainly the posterior left atrial wall and non-PV triggers induced by isoproterenol) (44.5%) in a stepwise approach. Patients were followed for 15 months with stringent arrhythmia monitoring. The primary effectiveness endpoint, which included freedom from atrial arrhythmias lasting longer than 30 seconds, was achieved in 62% of patients. The primary safety endpoint was also met, with a remarkably low rate of adverse events (4.1%). Further, clinical success was achieved in 80% of patients, 86.1% of patients remained free from repeat ablation, and there was a significant reduction in health-care resource utilization.

An indirect comparison of the workflows and atrial arrhythmia recurrence rates between PRECEPT and other multicenter persistent atrial fibrillation (AF) studies such as STAR AF II,² STOP Persistent AF,³ TOUCH AF,⁴ and CRYO4PERSISTENT AF⁵ suggests better outcomes exist in PRECEPT. The PRECEPT trial is also significant as the first prospective multicenter study performed using contact force sensing. It demonstrated that freedom from atrial arrhythmias can be achieved in a large percentage of patients, while suggesting that, in persistent AF, the ablation of non-PV targets in addition to PVI is necessary. Future work involving the mapping of non-PV targets is of the utmost importance.

Persistent AF ablation is likely to proliferate as paroxysmal AF ablation did more than one decade ago. Future research should emphasize patient-centric outcomes such as AF burden reduction and long-term health-care use to guide treatment decisions in this area.

Sincerely,

Moussa Mansour, MD, FHRS, FACC

Editor in Chief

The Journal of Innovations in Cardiac Rhythm Management

MMansour@InnovationsInCRM.com

Director, Atrial Fibrillation Program

Jeremy Ruskin and Dan Starks Endowed Chair in Cardiology

Massachusetts General Hospital

Boston, MA 02114

References

1. Mansour M, Calkins H, Osorio J, et al. Persistent atrial fibrillation ablation with contact force sensing catheter: The prospective multicenter PRECEPT Trial. JACC Clin Electrophysiol. May 2020. In press. [CrossRef]
2. Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812–1822.
3. Calkins H. Arctic Front Advance Cryoballoon Ablation for Persistent Atrial Fibrillation: 12 Month Efficacy and Safety Results from the Global Perspective Multicenter STOP PERSISTENT AF Study. Presented at the 25th Annual International AF Symposium; January 23–25, 2020; Washington, D.C.
4. Conti S, Weerasooriya R, Novak P, et al. Contact force sensing for ablation of persistent atrial fibrillation: a randomized, multicenter trial. Heart Rhythm. 2018;15(2):201–208. [CrossRef] [PubMed]
5. Boveda S, Metzner A, Nguyen DQ, et al. Single-procedure outcomes and quality-of-life improvement 12 months post-cryoballoon ablation in persistent atrial fibrillation: results from the multicenter CRYO4PERSISTENT AF trial. JACC Clin Electrophysiol. 2018;4(11):1440–1447. [CrossRef] [PubMed]