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Utility of acute arrhythmia termination as an ablation endpoint for induced atrial tachyarrhythmia after complete pulmonary vein isolation during catheter ablation for persistent atrial fibrillation

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Abstract

Purpose

The presence of inducible atrial tachyarrhythmia after pulmonary vein isolation (PVI) during radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) may indicate the necessity of further substrate modification, but the optimal ablation endpoint is unknown. We sought to assess the impact of procedural termination of inducible atrial tachyarrhythmia after PVI in comparison with continued atrial tachyarrhythmia after PVI.

Methods

Among patients who underwent RFCA for persistent AF, we enrolled 93 patients who were in sinus rhythm after PVI and had inducible atrial tachyarrhythmia and 157 patients with continued atrial tachyarrhythmia after PVI. The impact of acute arrhythmia termination during further substrate modification on recurrence was compared between the two groups.

Results

Acute termination was achieved in 51 (54.8%) patients in the induced arrhythmia group and 61 (38.9%) in the continued arrhythmia group. During a mean 35.8 months, acute termination did not significantly reduce arrhythmia recurrence in the induced arrhythmia group (HR 0.712, 95% CI 0.400–1.266, p = 0.247), while it was associated with improved outcome in the continued arrhythmia group (HR 0.590, 95% CI 0.355–0.979, p = 0.038). Acute termination of either induced atrial tachycardia (AT) or induced AF was not associated with improved procedure outcome. Among the continued arrhythmia group, the benefit of acute termination was statistically significant in AT (HR 0.329, 95% CI 0.108–0.997, p = 0.039), but not in AF (HR 0.704, 95% CI 0.396–1.253, p = 0.233) after PVI.

Conclusions

Acute termination of induced rhythm is not a reliable ablation endpoint during substrate modification in patients with inducible arrhythmia after PVI.

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Acknowledgements

We would like to thank Seo Seung-Duk, Abbott Cardiac Rhythm Management Division, for his efforts in literature review and correction of the paper.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Young Choi, Sung-Hwan Kim & Yong-Seog Oh

  2. Department of Internal Medicine, Division of Cardiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea

    Ju Youn Kim

  3. Department of Internal Medicine, Division of Cardiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea

    Yoo Ri Kim

  4. Department of Internal Medicine, Division of Cardiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea

    Tae-Seok Kim

  5. Department of Internal Medicine, Division of Cardiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea

    Youmi Hwang & Ji-Hoon Kim

  6. Department of Internal Medicine, Division of Cardiology, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Sung-Won Jang & Tai-Ho Rho

  7. Department of Internal Medicine, Division of Cardiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Man Young Lee

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  1. Young Choi
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Correspondence to Sung-Hwan Kim or Yong-Seog Oh.

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Choi, Y., Kim, SH., Kim, J.Y. et al. Utility of acute arrhythmia termination as an ablation endpoint for induced atrial tachyarrhythmia after complete pulmonary vein isolation during catheter ablation for persistent atrial fibrillation. J Interv Card Electrophysiol 54, 25–34 (2019). https://doi.org/10.1007/s10840-018-0436-x

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  • DOI: https://doi.org/10.1007/s10840-018-0436-x

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