Impact of electrophysiological and pharmacological noninducibility following pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation

Abstract

BackgroundTwo methods for testing inducibility of atrial fibrillation (AF)—atrial pacing and isoproterenol infusion—have been proposed to determine the endpoint of catheter ablation. However, the utility of the combination for testing electrophysiological inducibility (EPI) and pharmacological inducibility (PHI) is unclear.MethodsAfter pulmonary vein isolation (PVI), inducibility of atrial tachyarrhythmia was assessed with the dual methods in 291 consecutive patients with AF (65% paroxysmal) undergoing initial catheter ablation.ResultsThe incidence of EPI was significantly higher in patients with persistent AF than paroxysmal AF (32.0% vs 11.7%, respectively, P < .001). The incidence of PHI was not significantly different between the two groups (25.2% vs 26.1%, respectively, P = .87). There was no significant difference in AF recurrence according to inducibility in paroxysmal AF. In persistent AF, however, patients achieving neither EPI nor PHI under PVI‐only strategy had significantly lower rates of AF recurrence than those achieving either EPI or PHI and consequently requiring additional ablation for inducible atrial tachyarrhythmia (68.5% vs 49.0%, respectively; log‐rank test, P = .022). In persistent AF, multivariate Cox regression analysis showed that achieving neither EPI nor PHI was a negative independent predictor of AF recurrence (HR 0.492, 95% CI 0.254‐0.916, P = .026).ConclusionsAchieving neither EPI nor PHI following PVI was associated with favorable outcome in patients with persistent AF. The combination of tests may discriminate patients responsive to the PVI‐only strategy. Further selective approaches are necessary to improve outcome for inducible atrial tachyarrhythmia in patients with persistent AF.

Role of inducibility and its dynamic change in the outcome of catheter ablation of atrial fibrillation: a single center prospective study

“…Leong‐Sit et al 16 investigated 144 patients with paroxysmal or persistent AF and found no statistical difference in recurrence rate regarding inducibility. The same results were reported from Santangeli et al 17 and Otsuka et al 20 Moreover, in a recent larger study from Lee et al 21 with 500 patients, inducibility was proven to be inferior to non‐PV triggers elimination in long‐term follow‐ups. Kawai et al 23 concentrated on patients with persistent AF and showed no benefit from non‐inducibility.…”

“…On the other hand, recent studies have shown opposite results and have questioned the role of inducibility as an endpoint criterium for the success of AF ablation 16,17,20–23 . Leong‐Sit et al 16 investigated 144 patients with paroxysmal or persistent AF and found no statistical difference in recurrence rate regarding inducibility.…”

“…12,13 On the other hand, recent studies have shown opposite results and have questioned the role of inducibility as an endpoint criterium for the success of AF ablation. 16,17,[20][21][22][23] Leong-Sit et al 16 Table 4).…”

“…Especially among these patients, AF/AT inducibility and change in inducibility status could be used as a procedural endpoint. Older observational studies were controversial concerning any prognostic value of inducibility as a procedural endpoint 6–11,15–23 . We conducted a prospective study of AF/AT inducibility with different protocols before and after the ablation, as well as different stimulation locations and assessed the role of it in predicting long‐term AF freedom.…”

“…Older observational studies were controversial concerning any prognostic value of inducibility as a procedural endpoint. [6][7][8][9][10][11][15][16][17][18][19][20][21][22][23] We conducted a prospective study of AF/AT inducibility with different protocols before and after the ablation, as well as different stimulation locations and assessed the role of it in predicting long-term AF freedom.…”