Key result
Ablation of persistent atrial fibrillation with ventricular pacing resulted in similar 1-year arrhythmia-free survival compared to ablation in sinus rhythm with atrial pacing (67% vs 78%, p=0.31).
Why the study?
It was unknown whether persistent AF ablation in sinus rhythm with atrial pacing versus in AF with ventricular pacing impacts catheter stability or arrhythmia recurrence.
Does mapping and ablation in atrial fibrillation with ventricular pacing improve catheter stability and prevent arrhythmia recurrence in patients undergoing first-time persistent AF ablation compared to ablation in sinus rhythm with atrial pacing?
Cohort (n=53)
Does mapping and ablation in atrial fibrillation with ventricular pacing improve catheter stability and prevent arrhythmia recurrence in patients undergoing first-time persistent AF ablation compared to ablation in sinus rhythm with atrial pacing?
Ablation of persistent AF during AF with ventricular pacing provides similar catheter stability and 1-year arrhythmia-free survival compared to ablation in sinus rhythm with atrial pacing.
Ventricular pacing during persistent AF ablation yields comparable outcomes; hypothesis-generating and should not change practice without randomized confirmation.
Background: Improved catheter stability is associated with decreased arrhythmia recurrence after atrial fibrillation (AF) ablation. Recently, atrial voltage mapping in AF was demonstrated to correlate better with scar as compared to mapping in sinus rhythm (SR). However, it is unknown whether ablation of persistent AF in sinus rhythm with atrial pacing or in atrial fibrillation with ventricular pacing results in differences in catheter stability or arrhythmia recurrence. Methods: We analyzed 53 consecutive patients undergoing first-time persistent AF ablation with pulmonary vein and posterior wall isolation: 27 were cardioverted, mapped, and ablated in sinus rhythm with atrial pacing, and 26 were mapped and ablated in AF with ventricular pacing. Ablation data was extracted from the mapping system and analyzed using custom MATLAB software to determine high-frequency (60Hz) catheter excursion as a novel metric for catheter spatial stability. Results: There was no difference in catheter stability as assessed by maximal catheter excursion, mean catheter excursion, or contact force variability between the atrial-paced and ventricular-paced patients. Ventricular-paced patients did have significantly greater mean contact forces compared to atrial-paced patients. One year arrhythmia-free survival was similar between the atrial paced and ventricular paced patients (78% vs 67%, p = 0.31). Conclusion: For patients with persistent AF, ablation in AF with ventricular pacing results in similar catheter stability and arrhythmia recurrence as compared to cardioversion and ablation in sinus rhythm with atrial pacing. Given the improved fidelity of mapping in AF, mapping and ablating during AF with ventricular pacing may be preferred.
No takes yet. Share an insight, caveat, or question.
Dai et al. (2020) conducted a cohort in persistent atrial fibrillation (n=53). Ablation in atrial fibrillation with ventricular pacing vs. Ablation in sinus rhythm with atrial pacing was evaluated on One year arrhythmia-free survival (p=0.31). Ablation of persistent atrial fibrillation with ventricular pacing resulted in similar 1-year arrhythmia-free survival compared to ablation in sinus rhythm with atrial pacing (67% vs 78%, p=0.31).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: