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Inducibility of Atrial Fibrillation and Flutter Following Pulmonary Vein Ablation

Authors

  • PETER LEONG-SIT M.D., M.Sc.,

    Corresponding author
    • Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
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  • MELISSA ROBINSON M.D.,

    1. Division of Cardiology, Department of Medicine, University of Illinois, Chicago, Illinois, USA
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  • ERICA S. ZADO PA-C,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • DAVID J. CALLANS M.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • FERMIN GARCIA M.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • DAVID LIN M.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • SANJAY DIXIT M.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • RUPA BALA M.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • MICHAEL P. RILEY M.D., Ph.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • MATHEW D. HUTCHINSON M.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • JOSHUA COOPER M.D.,

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • EDWARD P. GERSTENFELD M.D.,

    1. Cardiovascular Division, Department of Medicine, University of California, San Francisco, California, USA
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  • FRANCIS E. MARCHLINSKI M.D.

    1. Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • E.P. Gerstenfeld reports participation on research grants supported by Biosense Webster and Medtronic. Other authors: No disclosures.

Address for correspondence: Peter Leong-Sit, M.D., London Health Sciences, University Hospital, 339 Windermere Rd, London, Ontario, Canada N5X 4L2. Fax: 519-663-3782; E-mail: pleongs@uwo.ca

Arrhythmia Inducibility Post-AF Ablation

 Introduction

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.

Conclusions

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.

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