Failure to terminate AF during index ablation predicted atrial tachyarrhythmia recurrence compared to termination at the PV antrum (HR 2.32; 95% CI 1.26-6.30; P=0.023).
Cohort (n=135)
Does the site and mode of atrial fibrillation termination during index catheter ablation predict atrial tachyarrhythmia recurrence in patients with persistent atrial fibrillation?
In patients undergoing catheter ablation for persistent atrial fibrillation, termination of AF at the pulmonary vein antrum and direct conversion to sinus rhythm are independent predictors of lower long-term arrhythmia recurrence.
Effect estimate: HR 2.32 (95% CI 1.26-6.30)
p-value: p=0.023
Background: Although atrial fibrillation (AF) termination has been reported as a predictor of clinical outcome after persistent AF (PsAF) ablation, the relationship between AF termination site and mode and clinical outcome has not been fully evaluated. Methods and Results: A total of 135 patients (62±9 years) underwent their first ablation procedure for PsAF (76 longstanding PsAF). With an endpoint of AF termination, the ablation procedure was performed sequentially in the following order: pulmonary vein (PV) antrum isolation, and left atrial and right atrial substrate modification. AF termination was achieved in 69 patients (51%; 24 at the PV antrum, and 45 in the atrium; direct conversion to sinus rhythm in 21, and atrial tachycardia AT in 48). With a mean of 1.7±0.7 procedures/patient, 100 patients (74%) were free from atrial tachyarrhythmia (ATa) during a median of 15.0 months of follow-up. During the initial procedure, the AF termination site (atrium vs. PV antrum, hazard ratio HR, 1.38; 95% confidence interval CI: 0.72–3.77; no termination vs. PV antrum, HR, 2.32; 95% CI: 1.26–6.30; P=0.023) and mode (AT vs. sinus rhythm, HR, 1.47; 95% CI: 0.77–4.01; no termination vs. sinus rhythm, HR, 2.38; 95% CI: 1.26–6.46; P=0.017) were independent predictors of ATa recurrence after the last ablation procedure. Conclusions: The site and mode of AF termination during the index ablation procedure predict ATa recurrence following multiple catheter ablation procedures for PsAF. (Circ J 2014; 78: 78–84)
Miyazaki et al. (Sat,) conducted a cohort in Persistent atrial fibrillation (PsAF) (n=135). Catheter ablation vs. AF termination at pulmonary vein antrum or sinus rhythm was evaluated on Atrial tachyarrhythmia (ATa) recurrence (HR 2.32, 95% CI 1.26-6.30, p=0.023). Failure to terminate AF during index ablation predicted atrial tachyarrhythmia recurrence compared to termination at the PV antrum (HR 2.32; 95% CI 1.26-6.30; P=0.023).