Catheter ablation for persistent atrial fibrillation: A multicenter randomized trial of pulmonary vein isolation (PVI) versus PVI with posterior left atrial wall isolation (PWI) - The CAPLA study

David Chieng, Hariharan Sugumar, Liang Han Ling, Louise Segan, Sonia Azzopardi, Sandeep Prabhu, Ahmed Al-Kaisey, Aleksandr Voskoboinik, Ramanathan Parameswaran, Joseph B. Morton, Bhupesh Pathik, Alex J. McLellan, Geoffrey Lee, Michael Wong, Sue Finch, Rajeev K. Pathak, Deep Chandh Raja, Prashanthan Sanders, Laurence Sterns, Matthew GinksChristopher M. Reid, Jonathan M. Kalman, Peter M. Kistler

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background: The success of pulmonary vein isolation (PVI) is reduced in persistent AF (PsAF) compared to paroxysmal AF. Adjunctive ablation strategies have failed to show consistent incremental benefit over PVI alone in randomized studies. The left atrial posterior wall is a potential source of non-PV triggers and atrial substrate which may promote the initiation and maintenance of PsAF. Adding posterior wall isolation (PWI) to PVI had shown conflicting outcomes, with earlier studies confounded by methodological limitations. Objectives: To determine whether combining PWI with PVI significantly improves freedom from AF recurrence, compared to PVI alone, in patients with PsAF. Methods: This is a multi-center, prospective, international randomized clinical trial. 338 patients with symptomatic PsAF refractory to anti-arrhythmic therapy (AAD) will be randomized to either PVI alone or PVI with PWI in a 1:1 ratio. PVI involves wide antral circumferential pulmonary vein (PV) isolation, utilizing contact force sensing ablation catheters. PWI involves the creation of a floor line connecting the inferior aspect of the PVs, and a roof line connecting the superior aspect of the PVs. Follow up is for a minimum of 12 months with rhythm monitoring via implantable cardiac device and/or loop monitor, or frequent intermittent monitoring with an ECG device. The primary outcome is freedom from any documented atrial arrhythmia of > 30 seconds off AAD at 12 months, after a single ablation procedure. Conclusions: This randomized study aims to determine the success and safety of adjunctive PWI to PVI in patients with persistent AF.

Original languageEnglish
Pages (from-to)210-220
Number of pages11
JournalAmerican Heart Journal
Publication statusPublished or Issued - Jan 2022
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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