New ablation approach improves outcomes for persistent atrial fibrillation
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Atrial fibrillation is the most common cardiac arrhythmia and increases the risk of conditions such as stroke and heart failure. An established treatment is catheter ablation, in which physicians use thin catheters to create small scars in heart tissue to block the electrical signals that cause the arrhythmia. Despite treatment, many patients with the more difficult-to-treat form, persistent atrial fibrillation, experience recurrence.
Researchers at Karolinska Institutet and Karolinska University Hospital investigated whether outcomes can be improved by also treating areas in the heart's left atrium that show signs of fibrosis or scarring. These areas are identified as so-called low-voltage zones, where the electrical signal is weaker than in healthy heart tissue.
The study was conducted at five Swedish hospitals and included 209 patients with persistent atrial fibrillation and clearly defined low-voltage zones in the left atrium. Participants were randomly assigned to either standard treatment with pulmonary vein isolation or pulmonary vein isolation combined with targeted treatment of the low-voltage zones. The patients were followed for 12 months.
The paper is published in the journal JAMA.
Better prognosis with a personalized strategy
The results showed that 67.6% of patients who received the combination treatment were free from atrial arrhythmias at follow-up, compared with 37.4% of patients who received standard treatment. The difference corresponds to approximately 30 percentage points.
"Patients with persistent atrial fibrillation and signs of extensive remodeling of the atria often have poorer treatment outcomes than other patients. Our results suggest that a more personalized ablation strategy may improve the prognosis for this group," says Nikola Drca, researcher at the Department of Medicine, Huddinge, Karolinska Institutet, and principal investigator of the study.
Improved quality of life
"We also found that patients who received the additional treatment reported greater improvements in health-related quality of life. At the same time, we could not identify any statistically significant difference in serious complications between the groups," says Astrid Paul-Nordin, affiliated researcher at the same department and the study's first author.
Publication details
Astrid Paul Nordin et al, Low-Voltage Ablation in Persistent Atrial Fibrillation, JAMA (2026). DOI: 10.1001/jama.2026.17274
Journal information: Journal of the American Medical Association
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CardiologyCommon illnesses & Prevention Provided by Karolinska Institutet Who's behind this story?
Swati Mestri
Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →
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