What is the clinical evidence from this study?

Study design: Cohort. Population: Persistent atrial fibrillation (PsAF) (n=135). Intervention: Catheter ablation vs. AF termination at pulmonary vein antrum or sinus rhythm. Primary outcome: Atrial tachyarrhythmia (ATa) recurrence (HR 2.32, 95% CI 1.26-6.30, p=0.023).

November 2, 2013Open Access

Impact of Atrial Fibrillation Termination Site and Termination Mode in Catheter Ablation on Arrhythmia Recurrence

Q: What does this research mean for the field?

Failure to terminate atrial fibrillation during the index ablation procedure predicts a higher risk of atrial tachyarrhythmia recurrence compared to termination at the pulmonary vein antrum. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Failure to terminate AF during index ablation predicted atrial tachyarrhythmia recurrence compared to termination at the PV antrum (HR 2.32; 95% CI 1.26-6.30; P=0.023).

Study Design

Type

Cohort (n=135)

Structured PICO

Does the site and mode of atrial fibrillation termination during index catheter ablation predict atrial tachyarrhythmia recurrence in patients with persistent atrial fibrillation?

Population

135 consecutive patients undergoing their first catheter ablation for persistent atrial fibrillation (PsAF) or longstanding PsAF, mean age 62±9 years, 85% male, at a single center in Japan.

Intervention

Catheter ablation with an endpoint of AF termination, performed sequentially (pulmonary vein antrum isolation, followed by left and right atrial substrate modification). The analysis evaluated the site (PV antrum vs. atrium) and mode (direct conversion to sinus rhythm vs. atrial tachycardia) of AF termination.

Comparator

Internal comparison between patients with different AF termination sites (PV antrum vs. atrium vs. no termination) and termination modes (sinus rhythm vs. atrial tachycardia vs. no termination).

Outcome

Freedom from atrial tachyarrhythmia (ATa) recurrence after the last ablation procedure during a median 15.0 months of follow-up.

In patients undergoing catheter ablation for persistent atrial fibrillation, termination of AF at the pulmonary vein antrum and direct conversion to sinus rhythm are independent predictors of lower long-term arrhythmia recurrence.

Main Result

Effect estimate: HR 2.32 (95% CI 1.26-6.30)

p-value: p=0.023

Abstract

Background: Although atrial fibrillation (AF) termination has been reported as a predictor of clinical outcome after persistent AF (PsAF) ablation, the relationship between AF termination site and mode and clinical outcome has not been fully evaluated. Methods and Results: A total of 135 patients (62±9 years) underwent their first ablation procedure for PsAF (76 longstanding PsAF). With an endpoint of AF termination, the ablation procedure was performed sequentially in the following order: pulmonary vein (PV) antrum isolation, and left atrial and right atrial substrate modification. AF termination was achieved in 69 patients (51%; 24 at the PV antrum, and 45 in the atrium; direct conversion to sinus rhythm in 21, and atrial tachycardia AT in 48). With a mean of 1.7±0.7 procedures/patient, 100 patients (74%) were free from atrial tachyarrhythmia (ATa) during a median of 15.0 months of follow-up. During the initial procedure, the AF termination site (atrium vs. PV antrum, hazard ratio HR, 1.38; 95% confidence interval CI: 0.72–3.77; no termination vs. PV antrum, HR, 2.32; 95% CI: 1.26–6.30; P=0.023) and mode (AT vs. sinus rhythm, HR, 1.47; 95% CI: 0.77–4.01; no termination vs. sinus rhythm, HR, 2.38; 95% CI: 1.26–6.46; P=0.017) were independent predictors of ATa recurrence after the last ablation procedure. Conclusions: The site and mode of AF termination during the index ablation procedure predict ATa recurrence following multiple catheter ablation procedures for PsAF. (Circ J 2014; 78: 78–84)

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