AB-453070-2 : A RANDOMIZED CONTROLLED TRIAL OF ELECTROGRAPHIC FLOW-GUIDED ABLATION IN REDO PATIENTS WITH NON-PAROXYSMAL ATRIAL FIBRILLATION

While pulmonary vein isolation (PVI) appears sufficient to treat most patients with persistent AF, there is a pressing need for technologies that can identify AF sources in who present redo procedures all PVs already isolated – increasingly encountered clinical situation. Electrographic Flow (EGF) mapping enables full spatiotemporal reconstruction of organized wavefront propagation, both active and estimate the consistency observed patterns. FLOW-AF multicenter, randomized, controlled study evaluate if EGF 1) stratify population non-paroxysmal by identifying extra-PV 2) guide ablation these sources. (NCT04473963) prospectively enrolled undergoing at 4 centers. Serial maps were obtained over 1-min recordings from multiple standardized basket positions atria. Patients source activity ≥ 26.5% randomized 1:1 PVI + EGF-guided vs control (PVI-only). If ablation, identified ablated until below threshold. no > threshold not received standard primarily PVI-only. Clinical follow-up EKG monitoring was performed 3, 6 12 months. In total, 85 enrolled: age 65.6±9.3 yrs; 37% female; mean LA diameter 4.4±0.6cm; duration 32.5±30.8 mo. Thirty-four (40%) had while 46 (60%) least 1 older (62.6 v. 68.2 yrs, p=0.005) higher CHA2DS2-VASc score (1.9 2.8, p=0.001) compared without Primary safety endpoint (freedom procedure-related serious adverse events 7 days) achieved 97.2%. efficacy successful (defined as eliminated upon post-ablation EGF-mapping) 95% ablation. Among patients, freedom mo 68% 17% Control (p=0.04); AF/AT/AFL 51% 14% (p=0.10), respectively. difficult-to-treat patients: 60% cohort; improves free survival year PVI-alone. Larger studies are warranted assess EGF-based AF/AT/AFL.