Why the study?
Despite increasing use of pulmonary vein isolation (PVI) for AF, many patients experience recurrence, and whether pre-procedural rhythm status impacts recurrence rates and clinical outcomes was unclear.
Does sinus rhythm at the time of pulmonary vein isolation reduce AF recurrence and hospitalizations in patients with atrial fibrillation?
Does sinus rhythm at the time of pulmonary vein isolation reduce AF recurrence and hospitalizations in patients with atrial fibrillation?
Being in sinus rhythm at the time of pulmonary vein isolation is associated with lower AF recurrence and reduced hospitalization rates compared to non-sinus rhythm.
Answers are grounded in this paper and cite their sources.
Non-sinus rhythm at PVI was associated with higher AF recurrence; leaves open whether pre-procedural rhythm optimization improves outcomes.
Background Pulmonary vein isolation (PVI) is increasingly recognized as a cornerstone treatment for paroxysmal and persistent atrial fibrillation (AF). Despite its growing usage, a notable number of patients experience arrhythmia recurrence. Aims To determine whether pre-procedural rhythm status impacts recurrence rates and clinical outcomes in AF patients treated with PVI. Methods Data were drawn from the Israeli Catheter Ablation Registry (ICAR), a prospective, multicenter registry of AF ablations conducted at 14 centers between January 2019 and December 2021. Patients were divided into two groups based on rhythm at the time of ablation: sinus rhythm and non-sinus rhythm. Baseline characteristics, procedural details, and follow-up data,including AF recurrence and hospitalization rates were prospectively collected. The primary outcome was post-blanking AF recurrence within a 2-year follow-up period. Results Among 1002 patients, 674 (67.3%) were in sinus rhythm and 328 (32.7%) in non-sinus rhythm at the time of PVI. Patients in sinus rhythm were younger (63.2 ±11.8 vs. 65.7 ±9.9 years, p<0.01), had higher left ventricular ejection fraction (LVEF) (56.1±9.2 vs. 51.0 ±12.1, p<0.01), and more commonly had paroxysmal AF (83.0% vs. 29.1%, p<0.01). The sinus rhythm group experienced significantly lower AF recurrence rates at 2 years (18.7% vs. 24.7%, p=0.03) and fewer hospitalizations (15.0% vs. 23.5%, p=0.001). A Multivariable COX proportional hazard regression model showed that non-sinus rhythm at PVI was independently associated with higher 1-year AF recurrence rates (HR 1.64, 95% CI [1.08-2.48], p=0.02). Conclusion Patients in sinus rhythm at the time of PVI exhibited lower AF recurrence rates and reduced hospitalization. These findings support a treatment approach focused on achieving and maintaining sinus rhythm before PVI to optimize outcomes in AF patients.
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Massalha et al. (2026) studied this question.
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