Key result
Targeted SVT trigger ablation linked to ~79% lower AF recurrence versus standard PVI.
Why the study?
Supraventricular tachycardias may trigger AF, prompting evaluation of the prevalence of SVT inducibility in patients referred for AF ablation and the effects of SVT ablation on AF recurrences.
Does targeted SVT ablation prevent AF recurrences in patients with paroxysmal AF and inducible SVT?
Observational (n=249)
No
Does targeted SVT ablation prevent AF recurrences in patients with paroxysmal AF and inducible SVT?
Absolute Event Rate: 8.5% vs 40%
In patients with paroxysmal AF and inducible SVT, targeted SVT ablation alone is highly effective at preventing AF recurrences, suggesting a simpler, tailored ablation strategy is viable for this subgroup.
May support targeted SVT ablation in select paroxysmal AF cases; leaves open need for confirmatory RCTs before practice change.
Aims: Supraventricular tachycardias may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences. Methods and results: 249 patients (mean age: 54 ± 14 years) referred for paroxysmal AF ablation were studied. In all patients, only AF relapses had been documented in the clinical history. 47 patients (19%; mean age: 42 ± 11 years) had inducible SVT during the electrophysiological study and underwent an ablation targeted only at SVT suppression. Ablation was successful in all 47 patients. The ablative procedures were: 11 slow-pathway ablations for atrioventricular nodal re-entrant tachycardia; 6 concealed accessory pathway ablations for atrioventricular re-entrant tachycardia; 17 focal ectopic atrial tachycardia ablations; 13 with only one arrhythmogenic pulmonary vein. No recurrences of SVT were observed during the follow-up (32 ± 18 months). 4 patients (8.5%) showed recurrence of at least one episode of AF. Patients with inducible SVT had less structural heart disease and were younger than those without inducible SVT. Conclusion: A significant proportion of candidates for AF ablation are inducible for an SVT. SVT ablation showed a preventive effect on AF recurrences. Those patients should be selected for simpler ablation procedures tailored only to the triggering arrhythmia suppression.
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Palamà et al. (2023) conducted an observational in Paroxysmal Atrial Fibrillation (n=249). SVT trigger-targeted ablation vs. Pulmonary vein isolation (PVI) was evaluated on Atrial fibrillation recurrences. Targeted ablation of isolated supraventricular tachycardia triggers in patients with paroxysmal atrial fibrillation resulted in an 8.5% AF recurrence rate over 32 months, compared to a 40% recurrence rate with standard pulmonary vein isolation.
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