Catheter ablation for AF originating from nonpulmonary vein ectopy had a higher recurrence rate than PV triggers alone (57.6% vs 38.8%; HR 2, 95% CI 1.4-2.85; P<0.001).
Cohort (n=660)
Does catheter ablation in patients with atrial fibrillation originating from nonpulmonary vein ectopy result in different recurrence rates compared to those with pulmonary vein triggers only?
Atrial fibrillation originating from nonpulmonary vein ectopy is associated with worse long-term outcomes and higher recurrence rates following catheter ablation compared to AF from pulmonary vein triggers alone.
Effect estimate: HR 2 (95% CI 1.4-2.85)
Absolute Event Rate: 57.6% vs 38.8%
p-value: p=<0.001
INTRODUCTION: Data regarding the long-term outcome of catheter ablation in patients with nonpulmonary vein (NPV) ectopy initiating atrial fibrillation (AF) are limited. We aimed to evaluate the long-term result of patients with AF who had NPV triggers and underwent catheter ablation. METHODS AND RESULTS: The study included 660 consecutive patients (age 54 ± 11 years old, 477 males) who had undergone catheter ablation for AF. Group 1 consisted of 132 patients with AF initiating from the NPV, and group 2 consisted of 528 patients with AF initiating from pulmonary vein (PV) triggers only. Patients from Group 1 were younger than those from Group 2 (51 ± 12 years old vs 54 ± 11 years old, P = 0.001) and were more likely to be females (34.4% vs 25.8%, P = 0.049). The incidences of nonparoxysmal AF (36.4% vs 16.3%, P < 0.001) and right atrial (RA) enlargement (31.3% vs 19%, P = 0.004) were higher, and the biatrial substrates were worse in Group 1 than those in Group 2 (left atrial voltage 1.5 ± 0.7 mV vs 1.9 ± 0.7 mV, P < 0.001, RA voltage 1.6 ± 0.5 mV vs 1.8 ± 0.6 mV, P = 0.014). During a follow-up period of 46 ± 23 months, there was a higher AF recurrence rate in Group 1 than in Group 2 (57.6% vs 38.8%, P < 0.001). The independent predictors of AF recurrence were NPV trigger (P < 0.001, HR 2, 95% CI 1.4-2.85), nonparoxysmal AF (P = 0.021, HR 1.55, 95% CI 1.07-2.24), larger left atrial diameter (P = 0.002, HR 1.04, 95% CI 1.02-1.07) and worse left atrial substrate (P = 0.028, HR 1.3, 95% CI 1.03-1.64). CONCLUSION: Compared to AF originating from the PV alone, AF originating from the NPV ectopy showed a worse outcome.
Chang et al. (Tue,) conducted a cohort in Atrial Fibrillation (n=660). Catheter ablation for AF with nonpulmonary vein (NPV) triggers vs. Catheter ablation for AF with pulmonary vein (PV) triggers only was evaluated on Atrial fibrillation recurrence (HR 2, 95% CI 1.4-2.85, p=<0.001). Catheter ablation for AF originating from nonpulmonary vein ectopy had a higher recurrence rate than PV triggers alone (57.6% vs 38.8%; HR 2, 95% CI 1.4-2.85; P<0.001).