Extensive Ablation vs. Pulmonary Vein Isolation in Persistent Atrial Fibrillation

For patients with paroxysmal atrial fibrillation (AF), pulmonary vein isolation (PVI) alone is clearly the most reasonable ablation strategy. However, for patients with persistent AF, it is unclear whether more-extensive ablation is needed to achieve success. In the VENUS trial, alcohol ablation of the vein of Marshall was beneficial for persistent AF (NEJM JW Cardiol Oct 27 2020 and JAMA 2020; 324:1620). Now, researchers in China report outcomes among 500 patients with persistent AF randomized to undergo PVI alone or PVI plus alcohol ablation of the vein of Marshall and linear ablation of the left atrial roof, mitral isthmus, and cavotricuspid isthmus (NCT04497376).

The primary endpoint — 12-month freedom from any documented atrial arrhythm…