OTTAWA, November 10, 2026 — New research led by the Ottawa Heart Institute and published in the Journal of the American Medical Association (JAMA) is helping answer an important question about how to improve treatment for people living with persistent atrial fibrillation (AF), the most common sustained heart rhythm disorder.
Persistent AF can be difficult to treat, and many patients experience a return of their abnormal heart rhythm after catheter ablation. Researchers have long debated whether treating additional areas of abnormal tissue in the heart could improve outcomes for these patients.
The study, known as COAST-AF, examined whether identifying and treating areas of abnormal electrical tissue in the heart, known as low-voltage areas, could improve long-term outcomes for patients with persistent AF. Led by Dr. Pablo Nery, staff cardiac electrophysiologist at the Ottawa Heart Institute, the trial enrolled 508 patients at 14 Canadian centres and was coordinated with support from the University of Ottawa Heart Institute Cardiovascular Research Methods Centre.
Research led by the Ottawa Heart Institute is shining new light on how physicians can better tailor ablation treatment for people living with persistent atrial fibrillation.
Our findings suggest that routinely adding this approach for all patients is unlikely to provide additional benefit. At the same time, they point to a group of patients who may benefit from this strategy, highlighting the importance of tailoring treatment to the individual rather than taking a one-size-fits-all approach.
- Pablo Nery, MD
“For years, physicians have debated whether ablation beyond standard of care pulmonary vein isolation could improve outcomes for patients with persistent atrial fibrillation,” said Dr. Nery, principal investigator of the trial. “Our findings suggest that routinely adding this approach for all patients is unlikely to provide additional benefit. At the same time, they point to a group of patients who may benefit from this strategy, highlighting the importance of tailoring treatment to the individual rather than taking a one-size-fits-all approach.”
The trial found that adding low-voltage area ablation did not significantly improve outcomes across the overall study population. However, among patients with identified low-voltage areas, the findings suggested the approach may reduce the risk of atrial fibrillation returning, highlighting the potential value of a more targeted treatment strategy.
The results align with recently published data and provide important evidence for clinicians making treatment decisions today and a strong rationale for individualized treatment of persistent AF patients with identified low-voltage areas.
Atrial fibrillation affects hundreds of thousands of Canadians and is associated with an increased risk of stroke, heart failure and hospitalization. Researchers say the findings will help guide future studies and inform clinical decision-making for patients with persistent AF.
For more information
Read “Low-Voltage Area Ablation for Persistent Atrial Fibrillation: The COAST–AF Randomized Clinical Trial” in the Journal of the American Medical Association.
To coordinate an interview with Dr. Pablo Nery of the Ottawa Heart Institute, please liaise with the media contact below.
Media contact
Leigh B. Morris
Communications Officer
University of Ottawa Heart Institute
613-316-6409 (cell)
lmorris@ottawaheart.ca