6/28/23, 1:15 AM DECAAF II Pathway Feedback Search Clinical Topics Home Studies DECAAF II DECAAF II Disease Atrial fibrillation Trial question Is MRI-guided fibrosis ablation superior to conventional catheter ablation in patients with persistent AF? Study design Multi-center Single blinded RCT Population Characteristics of study participants 21.0% female N = 843 79.0% male 843 patients (178 female, 665 male) Inclusion criteria: patients with persistent AF Key exclusion criteria: previous LA ablation or valvular cardiac surgery; contraindication to gadolinium and/or MRI; contraindication to -blockers Interventions N=421 MRI-guided fibrosis ablation (pulmonary vein isolation followed by ablation of all fibrotic areas observed on MRI) N=422 pulmonary vein isolation alone (electrical isolation of all pulmonary veins) Primary outcome https://web.pathway.md/studies/rec4zIbsfe6FaUQVO 1/2 6/28/23, 1:15 AM DECAAF II Pathway Atrial arrhythmia recurrence 46.1 % 46.1 43 34.6 % 23.1 % 11.5 % No significant difference 0.0 % MRI-guided fibrosis ablation Pulmonary vein isolation alone No significant difference in atrial arrhythmia recurrence (43% vs. 46.1%; HR 0.95, 95% CI 0.77 to 1.17) Secondary outcomes No significant difference in composite of atrial arrhythmia recurrence, repeat ablation or new atrial arrhythmia medication (45% vs. 48%; HR 0.95, 95% CI 0.78 to 1.16) No significant difference in repeat ablation (14% vs. 17.6%; HR 0.8, 95% CI 0.56 to 1.12) No significant difference in composite of atrial arrhythmia recurrence, repeat ablation, new atrial arrhythmia medication or cardioversion (45.9% vs. 48.5%; HR 0.96, 96% CI 0.79 to 1.17) Safety outcomes Significant differences in 1 event of death, stroke, pulmonary vein stenosis, HF, or bleeding within 30 days postablation (2.2% vs. 0%). Conclusion In patients with persistent AF, MRI-guided fibrosis ablation was not superior to pulmonary vein isolation alone with respect to atrial arrhythmia recurrence. Reference Nassir F Marrouche, Oussama Wazni, Christopher McGann et al. Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial. JAMA. 2022 Jun 21;327(23):2296-2305. Open reference URL https://web.pathway.md/studies/rec4zIbsfe6FaUQVO 2/2