Is Atrial Fibrillation Noninducibility by Burst Pacing After Catheter Ablation Associated With Reduced Clinical Recurrence?

Abstract

Background To date, there is no cumulative evidence supporting the association of atrial fibrillation (AF) noninducibility after ablation and freedom from AF. We performed a systematic review and meta‐analysis to determine whether AF noninducibility by burst pacing after catheter ablation is associated with reduced AF recurrence. Methods and Results We searched PubMed, Embase, Web of Science, and Cochrane Library databases through July 2019 to identify studies that evaluated AF noninducibility versus inducibility by burst pacing after catheter ablation for freedom from AF. A fixed effects model was used to estimate relative risk (RR) with 95% CIs. Twelve prospective cohort studies with AF noninducibility (n=1612) and inducibility (n=1160) were included. Compared with AF inducibility, AF noninducibility by burst pacing after ablation was associated with a reduced risk of AF recurrence (RR, 0.68; 95% CI, 0.60–0.77). Subgroup analysis showed that different AF types (paroxysmal AF and nonparoxysmal AF), different follow‐up times (≤6, 6–12, and >12 months), and different degrees of burst pacing (mild, moderate, severe) had no significant impact on the RRs. However, different cut‐off times for AF inducibility had a significant impact on the RR ( P interaction =0.009), and only the cut‐off time of 1 minute showed a significant correlation (RR, 0.54; 95% CI, 0.45–0.66). Conclusions AF noninducibility by burst pacing after catheter ablation is associated with reduced clinical recurrence of AF. Induction protocols with a different cut‐off time for AF inducibility have a significant impact on the correlation, and the AF ≥1 minute for AF inducibility is recommended.

A case report of successful treatment of longstanding persistent atrial fibrillation with ablation for fractionated potential with conduction delay during rapid pacing

“…AF noninducibility by rapid pacing is reported to be associated with a reduced clinical recurrence of AF. 14 …”

A Mechanistic Clinical Trial Using ( R )- Versus (S )-Propafenone to Test RyR2 (Ryanodine Receptor) Inhibition for the Prevention of Atrial Fibrillation Induction

“…Also, administration of only a single dose of study drug and completion of data collection at one study visit avoids the need for labor-intensive long-term follow-up. However, it should be acknowledged that while AF inducibility with rapid atrial pacing has been used to evaluate the efficacy of AF ablation, 23 the evidence to support its use for detecting pulmonary vein triggers due to RyR2-mediated calcium release is limited to animal models 6 and may not apply to humans. Another advantage of studying patients at the time of AF ablation is the opportunity to collect detailed electrophysiologic and hemodynamic data to define mechanisms, pharmacodynamics, and safety.…”