Concomitant Diabetes Mellitus Diminishes the Efficacy of Left Atrial Additional Ablation Following Pulmonary Vein Isolation ― A Subanalysis of the EARNEST-PVI Trial ―

BACKGROUND: The EARNEST-PVI trial showed that left atrial ablation in addition to pulmonary vein isolation (PVI) reduced atrial fibrillation (AF) recurrence after catheter ablation for persistent AF; however, the efficacy of left atrial additional ablation in patients with diabetes mellitus (DM) is not well known. The aim of this study was to evaluate the efficacy of left atrial additional ablation after PVI in patients with and without DM. METHODS AND RESULTS: This study, a subanalysis of the EARNEST-PVI trial, a multicenter, prospective, randomized, controlled trial, analyzed 493 consecutive patients undergoing initial radiofrequency catheter ablation for persistent AF. Patients were randomized to PVI alone (PVI-alone group) or PVI plus linear and/or complex fractionated atrial electrogram ablation (PVI-plus group). The primary outcome was defined as AF recurrence during the 12-month follow-up period after ablation. A total of 84 (17%) patients had DM. The primary outcome occurred in 120 (24%) patients. In patients without DM, freedom from AF recurrence was significantly higher in the PVI-plus group than in the PVI-alone group (80.0% vs. 71.1%, P=0.034). In contrast, in patients with DM, freedom from AF recurrence was similar between the PVI-plus and PVI-alone groups (75.4% vs. 72.9%, P=0.696). CONCLUSIONS: The efficacy of left atrial additional ablation after PVI in reducing AF recurrence following catheter ablation for persistent AF was diminished in patients with DM.