Augmented Wide Area Circumferential Catheter Ablation for Reduction of Atrial Fibrillation Recurrence - AWARE

May 24, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
Canadian Institutes of Health Research; University of Ottawa Heart Institute, Division of Cardiology and Academic Medical Organization; Biosense Webster
Date Published:
03/22/2023
Original Posted Date:
05/24/2023
References

Contribution To Literature:

The AWARE trial failed to show that double-wide circumferential ablation prevents recurrent atrial arrhythmias.

Description:

The goal of the trial was to evaluate double-wide circumferential ablation compared with single-wide circumferential ablation among patients with paroxysmal atrial fibrillation undergoing catheter ablation.

Study Design

  • Randomization
  • Parallel

Patients with paroxysmal atrial fibrillation were randomized to double-wide circumferential ablation (n = 203) vs. single-wide circumferential ablation (n = 195).

  • Total number of enrollees: 398
  • Duration of follow-up: 12 months
  • Mean patient age: 61 years
  • Percentage female: 33%
  • Percentage with diabetes: 10%

Inclusion criteria:

  • At least 18 years of age
  • Paroxysmal atrial fibrillation (refractory, intolerant, or unwilling to take antiarrhythmic drugs)

Exclusion criteria:

  • Persistent or permanent atrial fibrillation
  • Previous catheter or surgical ablation for atrial fibrillation
  • Presence of known intracardiac thrombus
  • Contraindication to systemic oral anticoagulation therapy
  • Significant valve disease (moderate or severe mitral/aortic stenosis or regurgitation)

Principal Findings:

The primary outcome, recurrent atrial arrhythmia, occurred in 24.6% of the double-wide circumferential ablation group vs. 26.7% of the single-wide circumferential ablation group (p = 0.64).

Secondary outcomes:

  • Repeat catheter ablation: 7.4% of the double-wide circumferential ablation group vs. 10.3% of the single-wide circumferential ablation group
  • Serious adverse events: 6.9% of the double-wide circumferential ablation group vs. 6.7% of the single-wide circumferential ablation group

Interpretation:

Among patients with paroxysmal atrial fibrillation, catheter ablation with a double-wide circumferential ablation failed to prevent recurrent atrial arrhythmias compared with a single-wide circumferential ablation. The need for repeat catheter ablation and serious adverse events were similar between treatment groups.

References:

Nair GM, Birnie DH, Nery PB, et al. Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation Recurrence: The AWARE Randomized Clinical Trial. JAMA Cardiol 2023;8:475-83.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Recurrence, Secondary Prevention


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