Post-procedural provocation of immediate recurrence of atrial premature beats and additional ablation significantly reduced the clinical recurrence rate of atrial fibrillation compared to no provocation (15.0% vs. 28.0%).
Cohort (n=200)
No
Does post-procedural provocation and additional ablation of immediate recurrence of atrial premature beats reduce clinical recurrence of atrial fibrillation in patients undergoing catheter ablation?
Post-procedural provocation and targeted ablation of immediate recurrence of atrial premature beats significantly reduces the clinical recurrence of atrial fibrillation without increasing complication rates.
Absolute Event Rate: 15% vs 28%
p-value: p=0.025
PURPOSE: The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation. MATERIALS AND METHODS: We enrolled 200 patients with AF (76.5% males; 57.4±11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (≥6/min) under isoproterenol infusion (5 μg/min), monitored for 10 min after internal cardioversion, and we ablated mappable IRAPBs. Post-procedural IRAPB provocations were conducted in 100 patients. We compared the patients who showed IRAPB with those who did not. We also compared the IRAPB provocation group with 100 age-, sex-, and AF-type-matched patients who completed ablation without provocation (No-Test group). RESULTS: 1) Among the post-procedural IRAPB provocation group, 33% showed IRAPB and required additional ablation with a longer procedure time (p=0.001) than those without IRAPB, without increasing the complication rate. 2) During 18.0±6.6 months of follow-up, the patients who showed IRAPB had a worse clinical recurrence rate than those who did not (27.3% vs. 9.0%; p=0.016), in spite of additional IRAPB ablation. 3) However, the clinical recurrence rate was significantly lower in the IRAPB provocation group (15.0%) than in the No-Test group (28.0%; p=0.025) without lengthening of the procedure time or raising complication rate. CONCLUSION: The presence of post-procedural IRAPB was associated with a higher recurrence rate after AF ablation. However, IRAPB provocation and additional ablation might facilitate a better clinical outcome. A further prospective randomized study is warranted.
Kim et al. (Thu,) conducted a cohort in Atrial fibrillation (n=200). Post-procedural IRAPB provocation and additional ablation vs. No provocation test (No-Test group) was evaluated on Clinical recurrence of atrial fibrillation (p=0.025). Post-procedural provocation of immediate recurrence of atrial premature beats and additional ablation significantly reduced the clinical recurrence rate of atrial fibrillation compared to no provocation (15.0% vs. 28.0%).