Linear Ablation and Ethanol Infusion via the Vein of Marshall and Persistent AF—Reply
In Reply The Letter from Dr Pei about the PROMPT-AF trial underscores the value of MRI-guided substrate modification for persistent AF, which potentially eliminates the initiation and maintenance of AF in a different way. This issue was explored in the DECAAF II randomized trial, which showed that the PVI plus MRI-guided fibrosis ablation did not result in a significant reduction of atrial arrhythmia recurrence compared with PVI alone. This disappointing result may be because not all fibrotic areas play an active role in AF, and it is currently unclear how to assess the arrhythmogenic propensity of the MRI-identified fibrosis. The individualized MRI-guided substrate ablation strategy may be one of the future trends for recurrent AF despite durable PVI and bidirectional linear block.
In Reply The Letter from Dr Pei about the PROMPT-AF trial underscores the value of MRI-guided substrate modification for persistent AF, which potentially eliminates the initiation and maintenance of AF in a different way. This issue was explored in the DECAAF II randomized trial, which showed that the PVI plus MRI-guided fibrosis ablation did not result in a significant reduction of atrial arrhythmia recurrence compared with PVI alone. This disappointing result may be because not all fibrotic areas play an active role in AF, and it is currently unclear how to assess the arrhythmogenic propensity of the MRI-identified fibrosis. The individualized MRI-guided substrate ablation strategy may be one of the future trends for recurrent AF despite durable PVI and bidirectional linear block.
