Key result
Supplementary ablation of non-pulmonary vein foci resulted in an 88.2% freedom from atrial fibrillation recurrence compared to 65.6% in patients with only pulmonary vein foci, though not statistically significant (P=0.088).
Why the study?
Does supplementary ablation of ATP and isoproterenol-induced non-pulmonary vein foci improve freedom from atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation undergoing circumferential pulmonary vein isolation?
Cohort (n=80)
No
Does supplementary ablation of ATP and isoproterenol-induced non-pulmonary vein foci improve freedom from atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation undergoing circumferential pulmonary vein isolation?
Absolute Event Rate: 88.2% vs 65.6%
p-value: p=0.088
ATP and isoproterenol administration effectively provokes non-pulmonary vein foci after pulmonary vein isolation, and supplementary ablation of these foci shows a trend toward improved freedom from atrial fibrillation recurrence.
Trend toward benefit from non-PV ablation; hypothesis-generating in this cohort and requires randomized confirmation before practice change.
OBJECTIVE: To evaluate the incidence and clinical outcome of adenosine triphosphate (ATP) plus isoproterenol (ISP)-induced non-pulmonary vein (PV) foci before and after circumferential PV isolation (CPVI) during index ablation in patients with paroxysmal atrial fibrillation (PAF). METHODS: In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation (AF) was provoked with ATP (20 mg) and ISP (20 µg/min) administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded. RESULTS: Before ablation, AF mostly originating from PVs (PV vs. non-PV, 36/70 vs. 3/70; P<0.01) was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked (post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016). Patients with pre- and post-CPVI induced AF (n=49) were divided according to non-PV foci being induced (group N, n=17) or not (group P, n=32). After mean (19.2±8.2) months follow-up, 88.2% (15/17) and 65.6% (21/32) of patients in groups N and P, respectively, were free from AF recurrence (P=0.088). CONCLUSIONS: ATP+ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.
No takes yet. Share an insight, caveat, or question.
Cheng et al. (2014) conducted a cohort in Paroxysmal atrial fibrillation (n=80). Supplementary ablation of non-pulmonary vein foci vs. Ablation of pulmonary vein foci only was evaluated on Freedom from atrial fibrillation recurrence (p=0.088). Supplementary ablation of non-pulmonary vein foci resulted in an 88.2% freedom from atrial fibrillation recurrence compared to 65.6% in patients with only pulmonary vein foci, though not statistically significant (P=0.088).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: