Ablation of non-pulmonary vein triggers resulted in a 38.2% 1-year recurrence rate versus 29.5% in patients without such triggers (adjusted HR 1.35; 95% CI 1.08-1.69).
Cohort (n=2,315)
Does the presence and successful ablation of non-pulmonary vein triggers impact the recurrence of atrial arrhythmias in patients undergoing first-time atrial fibrillation ablation?
Failure to ablate induced non-pulmonary vein triggers during first-time AF ablation is associated with a significantly higher risk of recurrence, whereas successful ablation reduces recurrence rates to levels approaching those of patients without such triggers.
Estimación del efecto: adjusted HR 1.35 (95% CI 1.08-1.69)
Tasa de eventos absoluta: 38.2% vs 29.5%
BACKGROUND Pulmonary veins (PVs) are major sources of atrial fibrillation (AF) triggers, but patients may also have non-PV (NPV) triggers. Data on the impact of targeting NPV triggers on AF ablation outcomes are limited. OBJECTIVES This study aimed to assess the outcome of patients undergoing AF ablation based on their NPV trigger status. METHODS Patients undergoing first-time AF ablation using radiofrequency energy between 2018 and 2023 who received trigger provocative maneuvers were included. The provocative maneuvers consisted of cardioversion of AF, incremental isoproterenol infusion (3, 6, 12, and 20-30 μg/min) and/or an atrial burst pacing protocol. NPV triggers were defined as ectopic foci initiating AF, sustained focal atrial tachycardia (AT), or atrioventricular nodal reentrant tachycardia. Recurrence was defined as AF/AT >30 seconds after a 90-day blanking period. RESULTS Of 2,315 patients included, 2,046 (88.4%) did not have NPV triggers, 233 (10.1%) had NPV triggers that were ablated, and 36 (1.6%) had NPV triggers that were not targeted or failed localization/ablation attempts. One-year recurrence rate was 29.5% in patients without NPV triggers, 38.2% in those with ablated NPV triggers (adjusted HR: 1.35; 95% CI: 1.08-1.69), and 72.2% in those with untreated NPV triggers (adjusted HR: 3.71; 95% CI: 2.48-5.54). This response pattern remained consistent regardless of NPV trigger subtype (AF vs focal AT) or provocation method (spontaneous vs induced triggers). CONCLUSIONS Failure to ablate induced NPV triggers is associated with a high risk of recurrence. Although the ablation of NPV triggers reduces recurrence rates to levels approaching those without such triggers, their presence indicates a modestly worse prognosis.
Oraii et al. (Sun,) conducted a cohort in Atrial fibrillation (n=2,315). Ablation of non-pulmonary vein (NPV) triggers vs. No NPV triggers was evaluated on Recurrence of AF/AT >30 seconds after a 90-day blanking period (adjusted HR 1.35, 95% CI 1.08-1.69). Ablation of non-pulmonary vein triggers resulted in a 38.2% 1-year recurrence rate versus 29.5% in patients without such triggers (adjusted HR 1.35; 95% CI 1.08-1.69).