Key result
Pulmonary vein isolation alone was associated with a higher risk of atrial fibrillation recurrence compared to adding non-pulmonary vein ablation (HR 1.34), particularly in patients with persistent AF.
Why the study?
The study was conducted to investigate the current status of catheter ablation for AF in Korea.
Does additional non-pulmonary vein ablation reduce atrial fibrillation recurrence compared to pulmonary vein isolation alone in patients undergoing catheter ablation?
Observational (n=2,402)
Yes
Does additional non-pulmonary vein ablation reduce atrial fibrillation recurrence compared to pulmonary vein isolation alone in patients undergoing catheter ablation?
In a large Korean prospective registry, performing additional non-pulmonary vein ablation during AF catheter ablation was associated with improved rhythm outcomes in patients with persistent AF, but not in those with paroxysmal AF.
Real-world Korean registry shows ~79% 1-year AF freedom after ablation; leaves open optimal lesion sets for persistent AF.
Background This study aims to investigate the current status of AF (atrial fibrillation) catheter ablation in Korea. Methods The patients who underwent AF catheter ablation from September 2017 to December 2019 were prospectively enrolled from 37 arrhythmia centers. Demographic data, procedural characteristics, the extent of catheter ablation, acute success of the ablation lesion set, rate and independent risk factor for recurrence of AF were analyzed. Results A total of 2402 AF patients [paroxysmal AF (PAF) 45.7%, persistent AF (PeAF) 43.1% and redo AF 11.2%] were included. Pulmonary vein isolation (PVI) was performed in 2378 patients (99%) and acute success rate was 97.9%. Additional non-PV ablation (NPVA) were performed in 1648 patients (68.6%). Post-procedural complication rate was 2.2%. One-year AF-free survival rate was 78.6% and the PeAF patients showed poorer survival rate than the ones with other types (PeAF 72.4%, PAF 84.2%, redo AF 80.0%). Additional NPVA did not influence the recurrence of AF in the PAF patients (PVI 17.0% vs. NPVA 14.6%, P value 0.302). However, it showed lower AF recurrence rate in the PeAF patients (PVI 34.9% vs. NPVA 24.4%, P value 0.001). Valvular heart disease, left atrial diameter, PeAF, PVI alone, need of NPVA for terminating AF, and failed ablation were independent predictors of AF recurrence. Conclusions Additional NPVA was associated better rhythm outcome in the patients with PeAF, not in the ones with PAF. The independent risk factors for AF recurrence in Korean population were similar to previous studies. Further research is needed to discover optimal AF ablation strategy.
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Lee et al. (2021) conducted an observational in Atrial fibrillation (n=2,402). Pulmonary vein isolation (PVI) alone vs. PVI and additional non-PV ablation (NPVA) was evaluated on Atrial fibrillation recurrence at 1 year (HR 1.34, 95% CI 1.104-1.619, p=0.003). Pulmonary vein isolation alone was associated with a higher risk of atrial fibrillation recurrence compared to adding non-pulmonary vein ablation (HR 1.34), particularly in patients with persistent AF.
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