Behavior-Based Electrogram Mapping Identifies Potential Functional Substrates in Atrial Fibrillation: The KSP-AF Randomized Study
In brief
Adding behavior-based mapping raised 24-month freedom from AF recurrence from 48% to 74%
In a single-center randomized trial of 100 patients having their first ablation, adding key spatiotemporal potential mapping to pulmonary vein isolation raised the share free of documented atrial fibrillation at 24 months, without antiarrhythmic drugs, from 48% to 74%. It also increased acute rhythm termination, but the results need confirmation in multicenter studies before wider adoption.
- Journal
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Q1)
- Published
- 2 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Mingli Zhou, Lin Li, Liyong Wu, Zhimin Ruan, Guofu Zhu, Li Zhang, et al.
- PMID
- 42967611
- DOI
- 10.1093/europace/euag308
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 2 November 2026): Randomized trial of AF ablation strategy and rhythm outcomes
Abstract
BACKGROUND AND AIMS: Conventional substrate mapping during atrial fibrillation (AF) may fail to capture dynamic electrogram behavior. Key spatiotemporal potentials (KSPs) are electrogram patterns identified by their temporal behavior during AF. We evaluated whether KSP-guided ablation improves outcomes beyond pulmonary vein isolation (PVI) and characterized their short-term frequency consistency. METHODS: In this single-center randomized study, 100 patients with paroxysmal or persistent AF undergoing first-time ablation were assigned to PVI plus KSP-guided ablation or PVI alone. The primary endpoint was 24-month single-procedure freedom from documented AF recurrence without antiarrhythmic drugs. Dominant frequency (DF) analysis included 93 KSP regions from 18 patients, assessed across four consecutive 5-second epochs. RESULTS: Acute AF termination occurred in 68% of patients with PVI + KSP versus 26% with PVI alone (P < 0.001). At 24 months, freedom from AF recurrence was 74% versus 48% (HR 0.38, 95% CI 0.18-0.79; P = 0.010), and freedom from AF/atrial tachycardia recurrence was 68% versus 46% (HR 0.49, 95% CI 0.25-0.97; P = 0.040). Within-recording temporal DF variability was low (coefficient of variation, 4.8 ± 1.2%). CONCLUSION: Adding KSP-guided ablation to PVI improved acute and 24-month rhythm outcomes in this single-center trial. These findings support further evaluation of behavior-based mapping to identify potential functional AF substrates and require multicenter confirmation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.