DECAAF II

Dr. Thomas Michael Tadros returns to the podcast to discuss the DECAAF II Randomized Clinical Trial. As a Board-certified Cardiologist and EP, Dr. Tadros’ gives us the pros and cons and takeaways from this study, that advances AFib knowledge within our specialty. The study, “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” was authored by Marrouche, Wazni, McGann et al and just released in June 2022 by JAMA. Key points from the paper: ● Question: Among patients with persistent atrial fibrillation (AF), does the addition of magnetic resonance imaging (MRI)-guided fibrosis ablation to conventional catheter ablation affect atrial arrhythmia recurrence? ● Findings: In this randomized clinical trial that included 843 patients with persistent AF, there was no significant difference in atrial arrhythmia recurrence in the MRI-guided fibrosis ablation group compared with the pulmonary vein isolation only group (hazard ratio, 0.95). ● Meaning: Findings do not support the use of MRI-guided fibrosis ablation for the treatment of persistent atrial fibrillation. All Things Afib is hosted by me, Dr. Armin Kiankhooy. As a board-certified cardiothoracic surgeon, my focus is on advanced treatments for heart and lung failure and minimally-invasive surgical treatments for atrial fibrillation such as the Hybrid Maze procedure. You can find me on staff at Adventist Health Heart and Vascular Institute in St. Helena California. Discussion points: ● Persistent vs. Paroxysmal Afib and background on the DECAAF I study ● Using MRIs to identify fibrosis prior to ablation ● Follow-up testing showed no differences - 43-46% of patients had a recurrence of AFib ● Patients were all approximately one year out from their diagnosis ● Even in patients with only 7 days of Afib, there was significant fibrosis – due to history of hypertension? ● Interstitial vs. replacement fibrosis ● Stroke incidence and mortality after the procedure ● Epicardial procedures - does this study impact? ● Where do we go with the data from this study? Does it impact practice? ● Scalability of this data/study/impact ● Overall these studies continue to be extremely relevant Resources: DECAAF II Study in JAMA Dr. Thomas Michael Tadros at Brigham and Women's Dr. Kiankhooy LinkedIn All Things AFib Website All Things AFib Twitter All Things AFib YouTube Channel