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Background <p>The role of prophylactic cavotricuspid isthmus (CTI) ablation remains controversial in atrial fibrillation (AF) patients without atrial flutter (AFL). Given the strong association between AF, AFL, and age, this study aimed to evaluate the impact of additional CTI ablation on recurrence-free survival, with a focus on age-stratified outcomes.</p> Methods <p>Between June 2020 and June 2022, 1226 paroxysmal AF patients without AFL who underwent first AF catheter ablation at Beijing Anzhen Hospital were enrolled. 899 patients underwent pulmonary vein isolation (PVI) alone (PVI group) and remaining 327 patients underwent additional CTI ablation (PVI + CTI group). Both groups were stratified into four age quartiles to assess age-related recurrence risk.</p> Results <p>Over a median 36.6-month follow-up, prophylactic CTI ablation did not have a better outcome in overall population. In the PVI + CTI group, the oldest age quartile (&gt; 70 years) was independently associated with a lower risk of recurrence compared with the youngest quartile (≤ 56 years; adjusted HR 0.41, 95% CI 0.18–0.97, <i>P</i> = 0.041). Age was not associated with outcome in PVI group. In patients aged &gt; 70 years, Kaplan–Meier analysis (log-rank <i>P</i> = 0.016) and interaction (P for interaction = 0.042) showed that the reduction of recurrence in the PVI + CTI group was significant. However, the outcome did not differ between the two groups among patients aged ≤ 70 years.</p> Conclusion <p>In paroxysmal AF patients without AFL, prophylactic CTI ablation was not associated with improved recurrence-free survival in the overall population, but may confer benefit in those aged &gt; 70 years.</p> Capsule summary <p>Prophylactic CTI ablation in addition to PVI did not improve outcomes in overall paroxysmal AF patients without AFL, but .was associated with significantly enhanced recurrence-free survival in those aged &gt;70 years.</p> Graphical Abstract <p></p>

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Prophylactic cavotricuspid isthmus ablation in addition to pulmonary vein isolation is associated with improved recurrence-free survival in patients aged > 70 years with paroxysmal atrial fibrillation

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Jia-Lin Li,
  • Jia-Hui Wu,
  • Xin Zhao,
  • Biao Fu,
  • Wei Wang,
  • Chang-Yi Li,
  • Rong-Hui Yu,
  • Nian Liu,
  • Xiao-Xia Liu,
  • Xue-Yuan Guo,
  • Song Zuo,
  • Meng-Meng Li,
  • Tong Liu,
  • Wen-He Lv,
  • Xue-Si Wang,
  • Xiao-Ying Liu,
  • Zhuo-Hang Du,
  • Xin-Ru Li,
  • Song-Nan Li,
  • Chen-Xi Jiang,
  • Cai-Hua Sang,
  • De-Yong Long,
  • Jian-Zeng Dong,
  • Chang-Sheng Ma,
  • Ri-Bo Tang

摘要

Background

The role of prophylactic cavotricuspid isthmus (CTI) ablation remains controversial in atrial fibrillation (AF) patients without atrial flutter (AFL). Given the strong association between AF, AFL, and age, this study aimed to evaluate the impact of additional CTI ablation on recurrence-free survival, with a focus on age-stratified outcomes.

Methods

Between June 2020 and June 2022, 1226 paroxysmal AF patients without AFL who underwent first AF catheter ablation at Beijing Anzhen Hospital were enrolled. 899 patients underwent pulmonary vein isolation (PVI) alone (PVI group) and remaining 327 patients underwent additional CTI ablation (PVI + CTI group). Both groups were stratified into four age quartiles to assess age-related recurrence risk.

Results

Over a median 36.6-month follow-up, prophylactic CTI ablation did not have a better outcome in overall population. In the PVI + CTI group, the oldest age quartile (> 70 years) was independently associated with a lower risk of recurrence compared with the youngest quartile (≤ 56 years; adjusted HR 0.41, 95% CI 0.18–0.97, P = 0.041). Age was not associated with outcome in PVI group. In patients aged > 70 years, Kaplan–Meier analysis (log-rank P = 0.016) and interaction (P for interaction = 0.042) showed that the reduction of recurrence in the PVI + CTI group was significant. However, the outcome did not differ between the two groups among patients aged ≤ 70 years.

Conclusion

In paroxysmal AF patients without AFL, prophylactic CTI ablation was not associated with improved recurrence-free survival in the overall population, but may confer benefit in those aged > 70 years.

Capsule summary

Prophylactic CTI ablation in addition to PVI did not improve outcomes in overall paroxysmal AF patients without AFL, but .was associated with significantly enhanced recurrence-free survival in those aged >70 years.

Graphical Abstract