Late-Breaking Science: Additional right atrial ablation after cryoablation for AF – does it work?
27 Aug 2023
Yesterday’s Late-Breaking Science session on atrial fibrillation (AF) included a presentation from Doctor Daehoon Kim (Severance Cardiovascular Hospital, Yonsei University College of Medicine - Seoul, Republic of Korea) on the findings of the CRALAL trial.
The investigators compared cryoballoon pulmonary vein isolation (Cryo-PVI) with versus without additional right atrial (RA) linear ablation to address whether rhythm outcomes could be improved in patients with persistent AF.
In this prospective, multicentre, open-label trial, conducted in the Republic of Korea, 289 patients with persistent AF were randomised to receive additional ablation from the superior vena cava to the RA septum and cavotricuspid isthmus ablation or to receive Cryo-PVI alone. The median age of participants was 63 years and three-quarters were men.
After median follow-up of 18 months, the primary endpoint of cumulative incidence of any atrial arrhythmia recurrence after a 3-month blanking period was significantly lower in the additional RA ablation group than in the Cryo-PVI alone group (35.6% versus 52.7%; hazard ratio [HR] 0.65; 95% CI 0.44 to 0.97; log-rank p=0.035).
Regarding secondary endpoints, antiarrhythmic drug (AAD) use after a 3-month blanking period was recorded in 43.8% of patients in the additional RA ablation group and in 49.7% of patients in the Cryo-PVI alone group. A composite secondary endpoint of any atrial arrhythmia recurrence or AAD use after a 3-month blanking period was significantly lower in the additional RA ablation group than in the Cryo-PVI alone group (HR 0.73; 95% CI 0.54 to 0.97; p=0.014). The total procedure time was longer in the additional RA ablation group (88 [IQR 76–100] versus 72 [IQR 62–82] minutes; p<0.001). Importantly, no difference was found in the complication rates between the two groups (3.4% in the additional RA ablation group versus 2.1% in the Cryo-PVI alone group; p=0.742).
Dr. Kim concludes, “Additional ablation from the superior vena cava to the RA septum and cavotricuspid isthmus ablation improved clinical outcomes of cryoballoon ablation for persistent AF. Our study warrants further replication to translate our findings into clinical practice.”