Key result
Achieving at least ipsilateral first-pass isolation during pulmonary vein isolation independently predicted a lower risk of atrial tachyarrhythmias recurrence (HR 0.46) in patients with persistent atrial fibrillation.
Why the study?
The study sought to evaluate the impact of first-pass isolation during pulmonary vein isolation on long-term clinical outcomes in patients with persistent atrial fibrillation undergoing radiofrequency ablation.
Does achieving first-pass pulmonary vein isolation improve freedom from atrial tachyarrhythmias in patients with persistent atrial fibrillation undergoing radiofrequency ablation?
Cohort (n=346)
No
Does achieving first-pass pulmonary vein isolation improve freedom from atrial tachyarrhythmias in patients with persistent atrial fibrillation undergoing radiofrequency ablation?
Hazard Ratio: 0.46 (95% CI 0.29–0.74)
p-value: p=0.001
IFPI may warrant procedural emphasis in persistent AF ablation; hypothesis-generating without randomized confirmation.
Background The achievement of first-pass isolation (FPI) during pulmonary vein isolation (PVI) generally serves as a reliable marker of lesion quality in initial radiofrequency encirclement and predicts favorable procedural outcomes. This study sought to evaluate the impact of the FPI on the long-term clinical outcomes in persistent atrial fibrillation (PeAF) patients undergoing radiofrequency ablation. Methods We conducted a retrospective analysis of 346 patients with PeAF who were divided into three groups: patients with FPI in bilateral PVs (BOTH group, n = 197), those with FPI in either ipsilateral PVs (EITHER group, n = 92), and those without FPI in bilateral PVs (NEITHER group, n = 57). Achieving FPI in at least one of the two ipsilateral PVs (at least ipsilateral FPI, IFPI) was utilized as a metric for evaluation. The primary endpoint was freedom from atrial tachyarrhythmias (ATAs) lasting longer than 30s beyond the blanking period. Baseline characteristics, procedural results and long-term clinical outcomes were compared among the groups. Result The FPI was effectively achieved in 251 left PVs (72.5%) and 235 right PVs (67.9%). After a median follow-up of 658(402, 970) days, the NEITHER group exhibited less freedom from ATAs recurrence than the BOTH group (57.9% vs. 75.1%, P < 0.001) or the EITHER group (57.9% vs. 70.7%, P = 0.036). IFPI was an independent predictor of freedom from ATAs recurrence in PeAF patients undergoing their initial ablation (HR, 0.46; 95% CI, 0.29–0.74; P = 0.001). Conclusion Achieving FPI for PVI remained a significant association with improved ablation outcomes in PeAF patients, wherein IFPI served as an important determinant.
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Luo et al. (2025) conducted a cohort in Persistent atrial fibrillation (n=346). At least ipsilateral first-pass isolation (IFPI) vs. No first-pass isolation in bilateral PVs (NEITHER group) was evaluated on Atrial tachyarrhythmias (ATAs) recurrence (HR 0.46, 95% CI 0.29-0.74, p=0.001). Achieving at least ipsilateral first-pass isolation during pulmonary vein isolation independently predicted a lower risk of atrial tachyarrhythmias recurrence (HR 0.46) in patients with persistent atrial fibrillation.
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