Repeat Ablation for Persistent Atrial Fibrillation: CFA/DOA-Guided Substrate Ablation Versus Re-PVI Alone in the Prematurely Terminated Randomized AF-CAM Trial

Background and Aims: Currently, no standard approach exists for substrate ablation in persistent atrial fibrillation (AF). This study aimed to assess whether repeat pulmonary vein isolation (Re-PVI) plus targeted substrate ablation improves long-term outcomes compared with Re-PVI alone in patients with persistent AF undergoing a second ablation.

Methods

The AF-CAM study is an investigator-initiated, prospective, randomized, open-label, blinded-endpoint, multi-center clinical trial. Patients with persistent AF undergoing a second ablation for arrhythmia recurrence were randomized 1:1 to either Group A (Re-PVI alone) or Group B (Re-PVI plus targeted ablation). The primary endpoint was freedom from any atrial arrhythmia (>30 s) between 3 and 12 months of follow-up.