Table 2 Open in new tab Overview of...

Study (year of publication)

Patients

Description

Primary endpoint

Outcome

STAR AF II (2015)^82,115

Persistent AF patients (n = 589)

Multicentre, prospective, single-blind, randomized trial
Three ablation strategies:

PVI plus CFAE ablation
PVI plus left atrial roof and mitral valve isthmus linear ablation
PVI only

During FU (3 months blanking period) freedom from AF recurrence (documented episode >30 s) after a single ablation procedure, with or without AADs

18 months FU
No significant differences in success rates between the three ablation strategies; 49, 46, and 59% of the patients experienced recurrences, respectively (P = 0.15)

DECAAF II (2022)^116,117

Persistent AF patients
(n = 843)

Multicentre, prospective, single-blind, randomized trial
Two ablation strategies:

PVI plus MRI atrial fibrosis guided ablation (Group 1)
PVI only (Group 2)

During FU period (90 day blanking period) first recurrence of AF, atrial flutter or AT (documented episode ≥30 s) after a single ablation procedure or repeat ablation

12–18 months FU
No significant difference in success rates between Group 1 and Group 2, 57.0 and 53.9%, respectively (P = 0.63)

STABLE-SR-II (2022)¹¹⁸

Persistent AF patients (n = 300)

Multicentre, prospective, single-blind, randomized trial
Two ablation strategies:

CPVI plus low-voltage area ablation and
CPVI only

During FU period (3 months blanking period) freedom from AF or AT (documented episode >30 s) after a single ablation procedure without the use of AADs

18 months FU
No significant difference in success rates between both ablation strategies, 67.2 and 67.4%, respectively. (P = 0.52)

ERASE-AF (2022)¹¹⁹

Persistent AF patients (n = 324)

Multicentre, prospective, open-label, randomized trial
Two ablation strategies:

PVI plus low-voltage area ablation
PVI only

During FU period (3 months blanking period) first recurrence of AF or AT (documented episode >30 s) after a single ablation procedure

12 months FU
Significantly higher success rate in the PVI + low voltage area ablation group compared with the PVI only group, 65 vs. 50%, respectively (log rank P = 0.006)

FLOW-AF (2024)¹²⁰

Persistent and long-standing persistent AF patients (n = 85)

Multicentre, prospective, open-label, randomized trial
Two (redo) ablation strategies:

PVI plus EGF-guided redo ablation
PVI only redo ablation

(Secondary effectiveness endpoint) During FU (3 month blanking period) freedom from AF, AT, or atrial flutter

12 months FU
Higher success rate in the PVI in combination with EGF-guided ablation group compared with the PVI only group, 51 vs. 14% (P = 0.103)

Study (year of publication)

Patients

Description

Primary endpoint

Outcome

STAR AF II (2015)^82,115

Persistent AF patients (n = 589)

Multicentre, prospective, single-blind, randomized trial
Three ablation strategies:

PVI plus CFAE ablation
PVI plus left atrial roof and mitral valve isthmus linear ablation
PVI only

During FU (3 months blanking period) freedom from AF recurrence (documented episode >30 s) after a single ablation procedure, with or without AADs

18 months FU
No significant differences in success rates between the three ablation strategies; 49, 46, and 59% of the patients experienced recurrences, respectively (P = 0.15)

DECAAF II (2022)^116,117

Persistent AF patients
(n = 843)

Multicentre, prospective, single-blind, randomized trial
Two ablation strategies:

PVI plus MRI atrial fibrosis guided ablation (Group 1)
PVI only (Group 2)

During FU period (90 day blanking period) first recurrence of AF, atrial flutter or AT (documented episode ≥30 s) after a single ablation procedure or repeat ablation

12–18 months FU
No significant difference in success rates between Group 1 and Group 2, 57.0 and 53.9%, respectively (P = 0.63)

STABLE-SR-II (2022)¹¹⁸

Persistent AF patients (n = 300)

Multicentre, prospective, single-blind, randomized trial
Two ablation strategies:

CPVI plus low-voltage area ablation and
CPVI only

During FU period (3 months blanking period) freedom from AF or AT (documented episode >30 s) after a single ablation procedure without the use of AADs

18 months FU
No significant difference in success rates between both ablation strategies, 67.2 and 67.4%, respectively. (P = 0.52)

ERASE-AF (2022)¹¹⁹

Persistent AF patients (n = 324)

Multicentre, prospective, open-label, randomized trial
Two ablation strategies:

PVI plus low-voltage area ablation
PVI only

During FU period (3 months blanking period) first recurrence of AF or AT (documented episode >30 s) after a single ablation procedure

12 months FU
Significantly higher success rate in the PVI + low voltage area ablation group compared with the PVI only group, 65 vs. 50%, respectively (log rank P = 0.006)

FLOW-AF (2024)¹²⁰

Persistent and long-standing persistent AF patients (n = 85)

Multicentre, prospective, open-label, randomized trial
Two (redo) ablation strategies:

PVI plus EGF-guided redo ablation
PVI only redo ablation

(Secondary effectiveness endpoint) During FU (3 month blanking period) freedom from AF, AT, or atrial flutter

12 months FU
Higher success rate in the PVI in combination with EGF-guided ablation group compared with the PVI only group, 51 vs. 14% (P = 0.103)

Table 2

Open in new tab

Overview of studies and trials of tailored-ablation approaches using the identification of patient-specific biomarkers

Study (year of publication)	Patients	Description	Primary endpoint	Outcome
STAR AF II (2015)^82,115	Persistent AF patients (n = 589)	Multicentre, prospective, single-blind, randomized trial Three ablation strategies: PVI plus CFAE ablation PVI plus left atrial roof and mitral valve isthmus linear ablation PVI only	During FU (3 months blanking period) freedom from AF recurrence (documented episode >30 s) after a single ablation procedure, with or without AADs	18 months FU No significant differences in success rates between the three ablation strategies; 49, 46, and 59% of the patients experienced recurrences, respectively (P = 0.15)
DECAAF II (2022)^116,117	Persistent AF patients (n = 843)	Multicentre, prospective, single-blind, randomized trial Two ablation strategies: PVI plus MRI atrial fibrosis guided ablation (Group 1) PVI only (Group 2)	During FU period (90 day blanking period) first recurrence of AF, atrial flutter or AT (documented episode ≥30 s) after a single ablation procedure or repeat ablation	12–18 months FU No significant difference in success rates between Group 1 and Group 2, 57.0 and 53.9%, respectively (P = 0.63)
STABLE-SR-II (2022)¹¹⁸	Persistent AF patients (n = 300)	Multicentre, prospective, single-blind, randomized trial Two ablation strategies: CPVI plus low-voltage area ablation and CPVI only	During FU period (3 months blanking period) freedom from AF or AT (documented episode >30 s) after a single ablation procedure without the use of AADs	18 months FU No significant difference in success rates between both ablation strategies, 67.2 and 67.4%, respectively. (P = 0.52)
ERASE-AF (2022)¹¹⁹	Persistent AF patients (n = 324)	Multicentre, prospective, open-label, randomized trial Two ablation strategies: PVI plus low-voltage area ablation PVI only	During FU period (3 months blanking period) first recurrence of AF or AT (documented episode >30 s) after a single ablation procedure	12 months FU Significantly higher success rate in the PVI + low voltage area ablation group compared with the PVI only group, 65 vs. 50%, respectively (log rank P = 0.006)
FLOW-AF (2024)¹²⁰	Persistent and long-standing persistent AF patients (n = 85)	Multicentre, prospective, open-label, randomized trial Two (redo) ablation strategies: PVI plus EGF-guided redo ablation PVI only redo ablation	(Secondary effectiveness endpoint) During FU (3 month blanking period) freedom from AF, AT, or atrial flutter	12 months FU Higher success rate in the PVI in combination with EGF-guided ablation group compared with the PVI only group, 51 vs. 14% (P = 0.103)

Study (year of publication)	Patients	Description	Primary endpoint	Outcome
STAR AF II (2015)^82,115	Persistent AF patients (n = 589)	Multicentre, prospective, single-blind, randomized trial Three ablation strategies: PVI plus CFAE ablation PVI plus left atrial roof and mitral valve isthmus linear ablation PVI only	During FU (3 months blanking period) freedom from AF recurrence (documented episode >30 s) after a single ablation procedure, with or without AADs	18 months FU No significant differences in success rates between the three ablation strategies; 49, 46, and 59% of the patients experienced recurrences, respectively (P = 0.15)
DECAAF II (2022)^116,117	Persistent AF patients (n = 843)	Multicentre, prospective, single-blind, randomized trial Two ablation strategies: PVI plus MRI atrial fibrosis guided ablation (Group 1) PVI only (Group 2)	During FU period (90 day blanking period) first recurrence of AF, atrial flutter or AT (documented episode ≥30 s) after a single ablation procedure or repeat ablation	12–18 months FU No significant difference in success rates between Group 1 and Group 2, 57.0 and 53.9%, respectively (P = 0.63)
STABLE-SR-II (2022)¹¹⁸	Persistent AF patients (n = 300)	Multicentre, prospective, single-blind, randomized trial Two ablation strategies: CPVI plus low-voltage area ablation and CPVI only	During FU period (3 months blanking period) freedom from AF or AT (documented episode >30 s) after a single ablation procedure without the use of AADs	18 months FU No significant difference in success rates between both ablation strategies, 67.2 and 67.4%, respectively. (P = 0.52)
ERASE-AF (2022)¹¹⁹	Persistent AF patients (n = 324)	Multicentre, prospective, open-label, randomized trial Two ablation strategies: PVI plus low-voltage area ablation PVI only	During FU period (3 months blanking period) first recurrence of AF or AT (documented episode >30 s) after a single ablation procedure	12 months FU Significantly higher success rate in the PVI + low voltage area ablation group compared with the PVI only group, 65 vs. 50%, respectively (log rank P = 0.006)
FLOW-AF (2024)¹²⁰	Persistent and long-standing persistent AF patients (n = 85)	Multicentre, prospective, open-label, randomized trial Two (redo) ablation strategies: PVI plus EGF-guided redo ablation PVI only redo ablation	(Secondary effectiveness endpoint) During FU (3 month blanking period) freedom from AF, AT, or atrial flutter	12 months FU Higher success rate in the PVI in combination with EGF-guided ablation group compared with the PVI only group, 51 vs. 14% (P = 0.103)

AAD, antiarrhythmic drug; AF, atrial fibrillation; AT, atrial tachycardia; CFAE, complex fractionated atrial electrogram; CPVI, circumferential pulmonary vein isolation; EGF, electrographic flow; FU, follow-up; MRI, magnetic resonance imaging; PEERP, pacing at the end of the effective refractory period; PVI, pulmonary vein isolation.

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