Key result
Post-ablation noninducibility at pacing <200 ms is linked to ~40% lower atrial tachyarrhythmia recurrence.
Why the study?
It was unclear whether pacing maneuvers at the end of catheter ablation for AF predict postintervention atrial tachyarrhythmia recurrence, and whether predictive value depends on pacing cycle length and AF type.
Does noninducibility at short pacing cycle lengths predict reduced recurrence of atrial tachyarrhythmias in patients undergoing catheter ablation for AF?
Cohort (n=298)
No
Does noninducibility at short pacing cycle lengths predict reduced recurrence of atrial tachyarrhythmias in patients undergoing catheter ablation for AF?
Hazard Ratio: 0.6 (95% CI 0.4–0.96)
p-value: p=0.031
Noninducibility at short pacing cycle lengths (<200 ms) after AF ablation predicts long-term freedom from arrhythmia recurrence, particularly in patients with persistent AF.
Noninducibility at short cycle lengths may refine post-ablation recurrence risk assessment in persistent AF; leaves open whether it should guide additional lesions.
Background It is unclear whether pacing maneuver at the end of catheter ablation for atrial fibrillation (AF) predicts recurrence of atrial tachyarrhythmia postintervention. Objective To investigate whether the predictive value of incremental pacing maneuver after catheter ablation for AF depends on the pacing cycle length and type of AF. Methods This study included 298 consecutive patients who underwent initial catheter ablation for nonvalvular AF (61% paroxysmal AF [PAF], 39% persistent AF [PeAF]). Rapid atrial pacing was performed at the end of the procedure. We analyzed minimum coupling interval (CI) of pacing, arrhythmia‐inducibility, and atrial tachyarrhythmia recurrence in patients with PAF and PeAF. Results Patients were divided into the following three groups according to their response to pacing maneuver: AF‐inducible (inducible group; n = 86), noninducible at CI ≥200 ms (non‐CI ≥200 group; n = 100), and noninducible at CI <200 ms (non‐CI <200 group; n = 112). Kaplan‐Meier analysis showed that response to pacing maneuver was significantly associated with recurrence of atrial tachyarrhythmias ( P = .028). Cox‐regression analysis showed that non‐CI <200 was an independent predictor when the inducible group was used as a reference (hazard ratio 0.60, 95% confidence interval 0.40‐0.96, P = .031). However, when PAF and PeAF were analyzed separately, non‐CI <200 was an independent predictor only in PeAF. Conclusion Noninducibility with shorter CI predicted atrial tachyarrhythmia recurrence only for PeAF. Pacing CI and type of AF could influence the predictive value of atrial tachyarrhythmia recurrence.
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Tachibana et al. (2020) conducted a cohort in Nonvalvular atrial fibrillation (n=298). Noninducibility at pacing coupling interval <200 ms vs. AF-inducible group was evaluated on Recurrence of atrial tachyarrhythmias (HR 0.60, 95% CI 0.40-0.96, p=0.031). Noninducibility at a pacing coupling interval <200 ms independently predicted freedom from atrial tachyarrhythmia recurrence compared to inducibility (HR 0.60, p=0.031).
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