Key result
An intracardiac defibrillation threshold of > 5 J after radiofrequency catheter ablation was significantly associated with a higher risk of atrial fibrillation recurrence (HR 3.99).
Why the study?
To evaluate changes in the intracardiac defibrillation threshold before and after RFCA, and determine whether post-RFCA threshold predicts AF substrate and recurrence.
Does the intracardiac defibrillation threshold after radiofrequency catheter ablation predict atrial fibrillation recurrence in patients with persistent AF?
Observational (n=141)
No
Does the intracardiac defibrillation threshold after radiofrequency catheter ablation predict atrial fibrillation recurrence in patients with persistent AF?
An intracardiac defibrillation threshold > 5 J after radiofrequency catheter ablation serves as an independent predictor of atrial fibrillation recurrence in patients with persistent AF.
Post-ablation IDF threshold >5 J was associated with AF recurrence; hypothesis-generating and should not yet change practice.
Intracardiac defibrillation (IDF) is performed to restore sinus rhythm (SR) during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). This study aimed to investigate the change in the IDF threshold before and after RFCA during the ablation procedure and determine whether the IDF threshold after RFCA was associated with the AF substrate and AF recurrence. A total of 141 consecutive patients with drug-refractory persistent AF (age 62.5 ± 10.3 years, 84.4% male) were enrolled in this study. Before RFCA, we initially performed IDF with an output of 1 J. When IDF failed to restore SR, the output was gradually increased to 30 J. After RFCA, we attempted pacing-induced AF to provoke other focuses of AF. When AF was induced, we performed IDF again to terminate AF with outputs of 1 to 30 J. The change in the IDF threshold to restore SR before and after RFCA was evaluated. After RFCA, the IDF threshold for restoring SR significantly decreased (from 11.5 ± 8.6 J to 4.0 ± 3.8 J, P < 0.001). During the follow-up (24.3 ± 12.2 months), SR was maintained in 107 patients (75.9%). The multivariate analysis using a Cox proportional-hazards model revealed that an IDF threshold of > 5 J after RFCA was significantly associated with the AF recurrence (HR, 3.99; 95% confidence interval 1.93-8.22; P = 0.0001). RFCA decreased the IDF threshold for restoring SR in patients with persistent AF. The IDF output of > 5 J after RFCA could be a predictor of AF recurrence independent of the AF substrate.
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Yao et al. (2021) conducted an observational in Drug-refractory persistent atrial fibrillation (n=141). Intracardiac defibrillation threshold > 5 J after RFCA vs. Intracardiac defibrillation threshold ≤ 5 J after RFCA was evaluated on Atrial fibrillation recurrence (HR 3.99, 95% CI 1.93-8.22, p=0.0001). An intracardiac defibrillation threshold of > 5 J after radiofrequency catheter ablation was significantly associated with a higher risk of atrial fibrillation recurrence (HR 3.99).
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