AFFIRMO
Professor Gregory YH Lip (University of Liverpool - Liverpool, UK) began the session by discussing the AFFIRMO trial evaluating the efficacy of a mobile-health intervention implementing the Atrial Fibrillation Better Care (ABC) pathway in combination with comprehensive geriatric assessment (CGA) in older patients with AF and comorbidities. There was no reduction in unplanned hospitalisations compared with usual care. Prof. Lip commented, “The integrated ABC system was designed to improve guideline adherence but there was high baseline guideline adherence and low event rates, with low use of the mobile app and limited efficacy of CGA in this well-preserved population.”
PVI-SHAM-AF
Next, Professor Rolf Wachter (University Hospital Leipzig - Leipzig, Germany) presented the findings of the PVI-SHAM-AF trial, which investigated improvements in AF-related quality of life with catheter ablation compared with a sham procedure. The researchers found that the AFEQT summary score improved in both groups at 6 months but with no significant between-group difference. This finding was observed despite freedom from AF being substantially higher in the catheter ablation group compared with the sham group.
NEXAF
Results from the NEXAF trial were presented by Doctor Bjarne Nes (Norwegian University of Science and Technology - Trondheim, Norway). The researchers evaluated the impact of an exercise intervention consisting of 4–6 weeks of supervised high-intensity sessions, followed mainly by remote exercise monitoring and guidance using a smartwatch, app and a web-based platform. AF burden was significantly reduced in the exercise intervention group compared with usual care at 1 year, but significant differences in AFEQT score were not observed. The researchers also reported a 37% reduction in total hospitalisations and a 46% reduction in AF-related hospitalisations. Dr. Nes concluded: “The trial strengthens the arguments for broader implementation of structured, long-term exercise in AF care.”
IDEAL-AF
As described by Doctor Astrid Paul Nordin (Karolinska Institutet - Stockholm, Sweden), the IDEAL-AF trial investigated whether ablation of low-voltage zones (LVZs) in addition to PVI improved rhythm outcomes compared with PVI alone in patients with persistent AF and significant LVZ substrate. At 1 year, freedom from documented atrial arrhythmia lasting >30 seconds without antiarrhythmic drugs was achieved significantly more often with LVZ ablation plus PVI than with PVI alone (67.6% vs. 37.4%; p<0.001). Improvements in quality of life were also observed with LVZ ablation.