Work

Questioning the role of pulmonary vein isolation in multimorbid patients: A prospective analysis in more than 1400 AF patients

Year: 2025

Type: article

Abstract: BACKGROUND: Early rhythm control (ERC) improves cardiovascular outcomes in patients with atrial fibrillation (AF) and a high comorbidity burden, but this benefit has been demonstrated primarily through antiarrhythmic drug therapy. It remains unclear whether catheter ablation-particularly pulmonary vein isolation (PVI)-achieves comparable efficacy in this high-risk population. OBJECTIVE: We aimed to assess the long-term effectiveness and safety of PVI in multimorbid patients with AF. METHODS: -VA score; a score of ≥4 defined high comorbidity burden. The primary end point was the recurrence of any atrial arrhythmia after a 90-day blanking period. Secondary end points included procedural safety and mortality. RESULTS: Over a mean follow-up of 2 years (range 6 months to 5 years), recurrence rates were significantly higher in patients with high vs low comorbidity burden at 5 years (Kaplan-Meier event rates: 64.4% vs 53.1%; HR 1.26; 95% CI 1.03-1.53; P = .01). Age ≥75 years was the only independent predictor of recurrence. Safety outcomes and procedural safety were similar across groups. CONCLUSION: Despite the established prognostic benefit of ERC in multimorbid patients, long-term rhythm control with PVI is significantly less effective in this population. These findings question routine first-line use of ablation-based strategies in patients most likely to benefit from rhythm control, highlighting the need for randomized trials comparing pharmacologic and ablative ERC in high-risk AF cohorts.

Source: Heart Rhythm

DOI: 10.1016/j.hrthm.2025.10.017