E.P. Gerstenfeld reports participation on research grants supported by Biosense Webster and Medtronic. Other authors: No disclosures.
Inducibility of Atrial Fibrillation and Flutter Following Pulmonary Vein Ablation
Article first published online: 6 FEB 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 6, pages 617–623, June 2013
How to Cite
LEONG-SIT, P., ROBINSON, M., ZADO, E. S., CALLANS, D. J., GARCIA, F., LIN, D., DIXIT, S., BALA, R., RILEY, M. P., HUTCHINSON, M. D., COOPER, J., GERSTENFELD, E. P. and MARCHLINSKI, F. E. (2013), Inducibility of Atrial Fibrillation and Flutter Following Pulmonary Vein Ablation. Journal of Cardiovascular Electrophysiology, 24: 617–623. doi: 10.1111/jce.12088
- Issue published online: 4 JUN 2013
- Article first published online: 6 FEB 2013
- Accepted manuscript online: 2 JAN 2013 04:10AM EST
- Manuscript Accepted: 24 DEC 2012
- Manuscript Revised: 17 DEC 2012
- Manuscript Received: 9 SEP 2012
- Biosense Webster and Medtronic
- atrial fibrillation;
- atrial tachyarrhythmias;
- catheter ablation;
- pulmonary vein isolation
Arrhythmia Inducibility Post-AF Ablation
Prior reports demonstrate prognostic value in noninducibility of atrial arrhythmias after atrial fibrillation (AF) ablation and suggest their utility in guiding additional ablation lesion sets. The type and mechanism of induced atrial arrhythmias, their relationship to the underlying atrial substrate, and prognostic significance of induced organized atrial arrhythmias are unknown.
Methods and Results
One hundred forty-four patients (30 women; median age 60 years; 54% with paroxysmal AF) undergoing AF ablation (circumferential pulmonary vein isolation and focal ablation of nonvein triggers on isoproterenol) were evaluated prospectively. All underwent a standardized postablation induction protocol from the coronary sinus and right atrium: 15 beat burst pacing at 250 milliseconds and decrementing to 180 milliseconds. Sustained rhythms were defined as greater than 2 minutes Of 144 patients, 55 patients (38.2%) did not have sustained inducible arrhythmias. Fifty-two (36.1%) had inducible AF and 37 (25.7%) had inducible organized arrhythmias. A logistic regression analysis showed that age (OR 2.10 per decade; P = 0.003) and hypertension (OR 4.15; P = 0.009) were predictive of inducibility. However, inducibility of either AF or organized arrhythmias was not prognostic of clinical recurrence at 1 year postablation (P = 0.65). Furthermore, inducibility of organized arrhythmias did not predict clinical recurrence of an organized arrhythmia. Only LA size (OR 2.18; 95% CI 1.02–4.67; P = 0.04) and persistent AF (OR 2.43; 95% CI 1.09–5.40; P = 0.03) predicted atrial arrhythmia recurrence.
Multisite atrial burst pacing post-AF ablation induced organized rhythms in 25.7% and AF in 36.1% of patients after AF ablation. Hypertension and age predict inducibility of arrhythmias, but inducibility did not predict clinical recurrence in follow-up. Distinguishing organized atrial arrhythmias from AF did not yield any further prognostic information. The utility of aggressive stimulation protocols after AF ablation for prognosis and to guide therapy appears limited.