Electrogram-Guided Driver Ablation Versus Posterior Wall Isolation in Persistent AF: A Propensity-Matched Study.

Authors

Naidong Pang, Haifeng Shi, Ying Tian, Yanjiang Wang, Liang Shi, XingPeng Liu

Published in

Pacing and clinical electrophysiology : PACE. Sep 08, 2026. Epub Sep 08, 2026.

Abstract

The optimal adjunctive ablation strategy beyond pulmonary vein isolation (PVI) for persistent atrial fibrillation (PsAF) remains uncertain. This study compared the procedural characteristics, periprocedural safety, and 12-month rhythm outcomes of driver-guided ablation versus posterior wall isolation (PWI) in patients with PsAF.
This multicenter retrospective study included 303 consecutive patients with PsAF who underwent PVI plus driver-guided ablation (n = 201) or PVI plus PWI (n = 102). Propensity score matching using prespecified clinical, cardiac structural, and atrial substrate variables yielded 102 matched pairs. An exploratory subgroup analysis was conducted according to left atrial low-voltage area (LVA) burden.
In the overall cohort, procedure time was shorter in the PWI group than in the driver group (154.56 ± 38.85 vs. 189.70 ± 39.45 min; p < 0.001). At 12 months, the driver group showed higher rates of freedom from atrial arrhythmias (75.1% vs. 63.7%; p = 0.038) and freedom from AF (80.1% vs. 67.6%; p = 0.017), and a lower proportion of persistent atrial arrhythmia among patients with recurrence (28.0% vs. 64.9%; p < 0.001). Periprocedural complications were comparable between groups. In the matched cohort, these findings remained materially unchanged. In patients with LVA burden ≥10%, driver ablation was associated with a higher rate of freedom from atrial arrhythmias than PWI (68.2% vs. 50.9%; p = 0.046), although no significant interaction was observed.
In patients with PsAF, PWI was associated with greater procedural efficiency, whereas driver-guided ablation was associated with better 12-month rhythm outcomes. These observational findings should be considered hypothesis-generating and require prospective validation.

PMID:
42711656
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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