Po-01-164 catheter ablation with morphologic repetitiveness ablation on persistent atrial fibrillation: a prospective multicenter trial

Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. AF drivers could be accurately identified by PeRIodicity and SiMilarity (PRISM) mapping and ablated. We aimed to determine whether PRISM mapping can improve ablation results for persistent AF when added to pulmonary vein isolation (PVI). This PRISM trial was an investigator-initiated, multicenter, prospective, single-blinded trial conducted at three centers across Asia. Patients with persistent AF referred for ablation were enrolled from June 2019 to December 2020. Patients were assigned to the PRISM-guided approach (Group 1, Figure) or the conventional approach (Group 2) at a 1:1 ratio. Outcome assessments were blinded to the treatment received. The primary outcome was freedom from AF for longer than 30 seconds at 6 and 12 months. 170 patients (age 62.0 ± 12.3 years; 136 men) were enrolled. We assigned 85 patients to group 1 and 85 patients to group 2. There were more group 1 patient who achieved freedom of AF at 12 months compared with group 2 patients. (71.6% [60/85] vs. 47.1% [40/85], p=0.003). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of AF [hazard ratio: 0.531, 95% confidence interval: 0.331-0.852, p=0.009]. Complication rates between the two groups were not significantly different. Our study showed that for persistent AF ablation, a specified substrate modification guided by PRISM mapping could eliminate AF sources and maintain sinus rhythm for 12 months.