Prospective Comparison of Echocardiographic Parameters following Pulmonary Vein Isolation or Pace and Ablate Strategy for Elderly Patients with Persistent Atrial Fibrillation

L. Wiedenmann (Wiesbaden)¹, A. Böhmer (Frankfurt am Main)², M. Rothe (Wiesbaden)¹, F. Doldi (Münster)³, F. Güner (Münster)³, J. Yogarajah (Bad Nauheim)⁴, M. Kuniss (Bad Nauheim)⁴, C. Jungen (Essen)⁵, H. Bogossian (Hagen)⁶, K. Iliodromitis (Hagen)⁷, D. Bastian (Fürth)⁸, V. Buia (Fürth)⁸, B. Schumacher (Kaiserslautern)⁹, V. Bilgeri (Innsbruck)¹⁰, S. Fichtner (Landshut)¹¹, F. Post (Frankfurt am Main)², S. Willems (Hamburg)¹², S. Feickert (Berlin)¹³, L. Eckardt (Münster)³, J. Ehrlich (Wiesbaden)^1
1St. Josefs Hospital Medizinische Klinik I Wiesbaden, Deutschland; ²Universitätsklinikum Frankfurt Med. Klinik III - Kardiologie, Angiologie Frankfurt am Main, Deutschland; ³Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; ⁴Kerckhoff Klinik GmbH Kardiologie Bad Nauheim, Deutschland; ⁵Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; ⁶Evangelisches Krankenhaus Hagen Haspe Klinik für Kardiologie und Intensivmedizin Hagen, Deutschland; ⁷Evangelisches Krankenhaus Hagen Haspe Klinik für Kardiologie und Rhythmologie Hagen, Deutschland; ⁸Klinikum Fürth Med. Klinik I - Kardiologie Fürth, Deutschland; ⁹Westpfalz-Klinikum GmbH Klinik für Innere Medizin 2 Kaiserslautern, Deutschland; ¹⁰Universitätsklinik für Innere Medizin III Kardiologie und Angiologie Innsbruck, Deutschland; ¹¹LAKUMED Kliniken – Krankenhaus Landshut-Achdorf Medizinische Klinik I - Kardiologie, Pneumologie und internistische Intensivmedizin Landshut, Deutschland; ¹²Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; ¹³Vivantes Klinikum Am Urban Klinik für Innere Medizin, Kardiologie und konservative Intensivmedizin Berlin, Deutschland

Background
Management of persistent atrial fibrillation (AF) includes rhythm and rate control. Given the high recurrence rates of AF following pulmonary vein isolation (PVI) in elderly patients (≥75 years), rate control via pacemaker (PM) implantation with atrioventricular node (AVN) ablation may represent a better alternative. Both interventions can differentially affect cardiac structure and function.

Objective
This prespecified echocardiographic sub-study of the ABLATE versus PACE trial aimed to assess short-term effects of PVI versus PM implantation with AVN ablation on cardiac structure and function.

Methods
In the investigator-initiated, non-industry-funded, international, prospective, randomised, open-label, superiority ABLATE versus PACE trial, 196 patients aged ≥75 years with persistent AF and preserved left ventricular ejection fraction (LVEF ≥50%) were randomized to undergo PVI (ABLATE) or dual-chamber PM implantation followed by AVN ablation 30 days later (PACE). Standardized transthoracic echocardiography was performed at baseline and 3 months post-intervention. The primary outcome was change in LVEF. Secondary outcomes included left atrial volume index (LAVI) and tricuspid annular plane systolic excursion (TAPSE). Between-group comparisons were adjusted for baseline values using linear mixed model analysis.

Results/ Conclusion
In accordance with publication policies governing the release of clinical trial data, the results of this prespecified sub-study cannot be disclosed prior to presentation and publication of the primary results of the ABLATE versus PACE trial. The findings of this sub-study will be presented at the DGK Congress.