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AF Symposium 25: AdmIRE: Predicting Recurrent Atrial Arrhythmias

Published: 16 Jan 2025

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AF Symposium 25 — The retrospective study using data from the admIRE trial (NCT05293639) suggests the occurrence of premature ventricular complexes (PVCs) early after atrial fibrillation (AF) ablation is a marker of increased risk of recurrent atrial arrhythmias.

In this interview, Dr William Whang (The Mount Sinai Hospital, New York, US) joins us onsite at AF Symposium 25 to discuss the study investigating whether PVCs after catheter ablation for paroxysmal AF can be used to predict recurrent atrial arrhythmias. Patients with paroxysmal AF from retrospective cohorts of admIRE, a multicenter, single-arm trial, were enrolled in the study and underwent weekly and then monthly transtelephonic monitoring.

Findings showed participants with early PVCs detected after PFA for PAF were at higher risk for recurrent atrial arrhythmias than patients who didn't have early PVCs.

Interview Questions:
1. What is the background of AdmIRE?
2. What was the study design and patient population?
3. What are the key findings?
4. What are your key take-home messages?
5. What further study is needed?

Recorded onsite at AF Symposium in Boston, 2025.

Editors: Yazmin Sadik, Jordan Rance
Videographers: Oliver Miles, David Ben-Harosh
Interviewer: David Ramsey
Support: This is an independent interview produced by Arrhythmia Academy.

Transcript

My name is Bill Whang. I'm a professor of medicine at Mount Sinai Hospital. I'm a practicing clinical cardiac electrophysiologist.

What is the background of AdmIRE?

The AdmIRE study was a previously published, single-arm, FDA trial of pulsed field ablation catheter for ablation of paroxysmal AFib. We did a secondary investigator-initiated analysis of the relationship between PVCs early after AFib ablation and recurrent atrial arrhythmias.

What was the study design and patient population?

Our patient population involved 361 participants who were in the pivotal and pilot phases of the AdmIRE study. They underwent transtelephonic monitoring, essentially weekly, for the first 5 months after ablation. We performed a regression analysis of the relationship between early PVCs within the first six months after ablation and one-year recurrent atrial arrhythmias.

What are the key findings?

Our key findings were that the odds of recurrent atrial arrhythmia were higher in the participants who had early PVCs detected. About 37% of the participants had early PVCs and their odds of recurrent atrial arrhythmia were about 2.1 times as high as those who didn't have early PVCs. The 95% confidence interval was 1.2 to 3.5 in multivariable analyses.

We performed, based on these results, we performed an exploratory analysis of a second trial that Biosense had conducted involving radiofrequency ablation, and we found similar results in the Q-FFICIENCY study. So, these results were consistent across the two energy forms.

What are your key take-home messages?

Take-home message is that PVCs early after AFib ablation seem to be a marker for increased risk of recurrent atrial arrhythmias, and we don't know yet what the mechanism is of the elevated risk associated with these PVCs.

What further study is needed?

Well, we definitely need to know whether this is consistent across other studies. We need to know the ideal time window to detect PVCs in terms of their predictability of recurrent atrial fibrillation, and we need to know why it's occurring in order to be able to potentially mitigate this increased risk. Potentially, PVCs could be a trigger for AFib based on the lack of AV coupling associated with the PVCs.

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