STAR AF II
Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II
Paciente / Población Intervención / Exposición Comparación Desenlace
In 589 patients with persistent atrial fibrillation, adding complex electrogram or linear ablation did not improve freedom from AF recurrence compared with pulmonary-vein isolation alone.
N
589
Diseño
Multicentre single-blind three-arm RCT
Desenlace
Freedom from documented AF recurrence >30 s after a single ablation at 18 months
Relevancia
2
Resultado59% (PVI alone) vs 49% (PVI + fractionated electrograms) vs 46% (PVI + linear ablation); P=0.15. Added substrate ablation gave no benefit.
Verma A, et al. N Engl J Med. 2015;372(19):1812-1822. 10.1056/NEJMoa1408288
Discusión y crítica
The PVI-alone arm was small, limiting power for that comparison, and single-procedure endpoint may understate outcomes. Established that in persistent AF, pulmonary-vein isolation alone is the default and additional lesions add risk without benefit.