Unsuccessful elimination of non-pulmonary vein triggers during persistent AF ablation independently predicted atrial tachyarrhythmia recurrence (HR 1.80; 95% CI 1.07-2.95; p=0.026).
Cohort (n=300)
Does successful elimination of non-pulmonary vein triggers improve freedom from atrial tachyarrhythmia recurrence in patients undergoing initial ablation for persistent atrial fibrillation?
Successful elimination of non-pulmonary vein triggers during initial ablation for persistent atrial fibrillation significantly improves long-term freedom from atrial tachyarrhythmia recurrence.
Effect estimate: HR 1.80 (95% CI 1.07-2.95)
Absolute Event Rate: 38.6% vs 68.3%
p-value: p=.026
BACKGROUND: The role of nonpulmonary vein (PV) triggers ablation in persistent atrial fibrillation (PEAF) was suggested but it is still under debate. OBJECTIVES: We aimed to assess the effectiveness of non-PV trigger-targeted ablation for patients with PEAF. METHODS: Consecutive patients with PEAF undergoing catheter ablation (CA) between January 2015 and April 2017 were enrolled. Isoproterenol plus adenosine challenge was performed to provoke non-PV triggers. Non-PV triggers were defined as the trigger beats inducing AF (non-PV AF triggers) and/or frequent premature contractions (non-PV PACs) from other than PVs. Three groups were defined: Group 1 (n = 186) without non-PV triggers; Group 2 (n = 65) with non-PV triggers that could be completely eliminated with CA; Group 3 (n = 49) with non-PV triggers still inducible after CA. The primary endpoint was freedom from any atrial tachyarrhythmia (ATa) recurrence. RESULTS: A total of 300 patients (230 males, age 64 ± 10) were enrolled. The mean follow-up period was 27 ± 10 months. Freedom from ATa recurrence at 1 and 2 years were significantly lower in Group 3 compared to the other two groups (Group 1; 74.7%, 67.2% vs. Group 2; 75.8%, 68.3% vs. Group 3: 52.1%, 38.6%, p = .0005), irrespective of the type of non-PV triggers (non-PV AF triggers vs. non-PV PACs). On multivariate analysis, unsuccessful elimination of non-PV triggers was an independent predictor for ATa recurrence (hazard ratio = 1.80, 95% confidence interval = 1.07-2.95, p = .026). CONCLUSION: Successful non-PV triggers elimination can improve the ATa recurrence rate in PEAF ablation. ATa recurrence rate is higher, if non-PV AF triggers or even non-PV PACs remain in patients with PEAF.
Tohoku et al. (2020) conducted a cohort in persistent atrial fibrillation (PEAF) (n=300). Non-PV trigger-targeted ablation vs. Successful elimination vs unsuccessful elimination vs no non-PV triggers was evaluated on freedom from any atrial tachyarrhythmia (ATa) recurrence (HR 1.80, 95% CI 1.07-2.95, p=.026). Unsuccessful elimination of non-pulmonary vein triggers during persistent AF ablation independently predicted atrial tachyarrhythmia recurrence (HR 1.80; 95% CI 1.07-2.95; p=0.026).