Cardiology · 3 h ago
KSP-Guided Ablation Improved Rhythm Outcomes in a Single-Center AF Trial
In a randomized, single-center study of 100 patients undergoing first-time ablation for paroxysmal or persistent atrial fibrillation, pulmonary vein isolation (PVI) plus key spatiotemporal potential (KSP)-guided ablation was compared with PVI alone. The KSP-guided group had higher freedom from documented AF recurrence at 24 months; multicenter confirmation is needed.
- KSP-guided ablation increased acute AF termination.
- 24-month freedom from AF recurrence was 74% versus 48%.
- The randomized trial was single-center and included 100 patients.
- Multicenter studies are needed to confirm the findings.
Conventional substrate mapping during atrial fibrillation (AF) may not capture changing electrogram behavior. The KSP-AF randomized study assigned 100 patients with paroxysmal or persistent AF undergoing first-time ablation to PVI plus KSP-guided ablation or PVI alone. The primary endpoint was single-procedure freedom from documented AF recurrence without antiarrhythmic drugs at 24 months. A separate analysis assessed dominant-frequency variability in 93 KSP regions from 18 patients across four consecutive 5-second epochs.
Acute AF termination occurred in 68% of patients receiving PVI plus KSP-guided ablation and 26% receiving PVI alone (P<0.001). At 24 months, freedom from AF recurrence was 74% versus 48% (HR 0.38, 95% CI 0.18–0.79; P=0.010). Freedom from AF or atrial tachycardia recurrence was 68% versus 46% (HR 0.49, 95% CI 0.25–0.97; P=0.040). Within-recording temporal dominant-frequency variability was low, with a coefficient of variation of 4.8±1.2%.
The findings suggest potential benefit from adding behavior-based mapping to PVI, but the evidence comes from a single-center trial and requires multicenter confirmation. The supplied abstract does not provide further details on trial limitations or adverse events.
In practice
For patients with paroxysmal or persistent AF undergoing first-time ablation, this single-center randomized study found higher 24-month freedom from documented AF recurrence when KSP-guided ablation was added to PVI than with PVI alone (74% vs 48%). Freedom from AF or atrial tachycardia recurrence was also higher (68% vs 46%). These results are promising but do not establish a change in practice: the trial enrolled 100 patients at one center, and the authors state that multicenter confirmation is needed.
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Europace: Behavior-Based Electrogram Mapping Identifies Potential Functional Substrates in Atrial Fibrillation: The KSP-AF Randomized Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.