Bilateral left lateral ridge ablation in patients with paroxysmal atrial fibrillation: study rationale and preliminary results
D Ciliberti, A Di Monaco, F Quadrini, F Troisi, N Vitulano, L Sgarra, V Perniciaro, N Caporusso, V P Caccavo, G Katsouras, R Caruso, V Anzelmo, M GrimaldiAbstract
Background/Introduction
Left lateral atrial ridge (LLR), sited between the orifices of the left pulmonary veins (PVs) and the left atrial appendage ostium, is a crossroads of different kinds of tissues. It is known as a substrate for atrial fibrillation (AF) triggers, but also as a challenging ablation site. We previously proposed the bilateral approach as a strategy to ablate this area.
Purpose
The aim of this study is to assess the feasibility, safety and efficacy of adding bilateral ablation of the left lateral ridge (BLLRA) to pulmonary vein isolation (PVI) in preventing arrhythmic recurrences in patients with paroxysmal AF.
Methods
We designed a 1:1 randomized, controlled, single-blinded, superiority trial enrolling consecutive patients undergoing first paroxysmal AF ablation. Patients were randomized to BLLRA plus PVI or to PVI only, performed using a variable loop pulse field ablation catheter supported by electro-anatomical mapping. The primary endpoint is freedom from atrial tachyarrhythmias 12 months after ablation. The secondary endpoint is a safety outcome. The sample size was calculated 121 patients per group. A structured follow up at 2, 6 and 12 months was settled. This is an interim analysis of the preliminary results of the trial.
Results
In this preliminary analysis, a total of 41 patients (mean age 61,5±8,4; male 61%) were enrolled between October 2024 and September 2025. 21 patients (mean age 61,5±6,8; male 76,2%) were randomized in BLLRA plus PVI group, whilst 20 patients in the PVI group (mean age 61,5±10; male 45%). Baseline characteristics were balanced between groups (fig.1). Two patients underwent the procedure but did not start the follow up. No differences were documented between groups considering procedural data, nor procedural times (fig.1 and 2). After 7,3±3,1 months of follow up, freedom from recurrent atrial arrhythmia (fig.1 and 2), without the use of antiarrhythmic medication and after 8 weeks of blanking period, was present in 18 of 20 patients (90%) assigned to BLLRA plus PVI, compared with 15 of 19 (78,9%) assigned to PVI alone (between-group difference, –11,9%; hazard ratio [HR], 0.52 [95% CI, 0.10-2,59]; log rank p = 0,43). Evaluating the type of arrhythmia, freedom from AF was documented in 90% of patients of the intervention group and 84,3% of the control group (log rank p = 0,69); whereas freedom from atrial flutter occurred in 100% of BLLRA plus PVI group and 94,8% in PVI only group (log rank p = 0,31). No events occurred concerning the safety outcome in the overall population. Two vascular complications occurred, one for each group, related to groin puncture issues.
Conclusion(s)
Bilateral left lateral ridge ablation plus pulmonary veins isolation is a feasible and safe treatment for paroxysmal atrial fibrillation. There is a favorable trend toward efficacy when compared to PVI only, but more data, patients and time are needed to provide definite evidence of superiority.TablesBLLRA plus PVI vs PVI comparison