Is inducibility of atrial fibrillation after radio frequency ablation really a relevant prognostic factor?

Abstract

Aims The study was intended to assess the prognostic value of inducibility of atrial fibrillation (AF) after radio frequency ablation. Methods and results Two hundred and thirty four patients with drug-resistant paroxysmal (n ¼ 165) or persistent AF (n ¼ 69) underwent either Lasso-guided segmental pulmonary vein isolation (n ¼ 83) or CARTO-guided left atrial circumferential ablation (n ¼ 151). After ablation, two attempts to induce AF (.1 min) by decremental coronary sinus stimulation were performed. Patients were followed for at least 6 months (median: 12.7 months). At 6 months of follow-up, 67% of patients with paroxysmal and 48% of patients with persistent AF were AF-free. Inducibility of AF was a significant predictor of AF recurrence in univariate [hazard ratio (HR) ¼ 2.32, P , 0.001] and multivariable (HR ¼ 2.19, P , 0.001) Cox regression analyses. The prognostic value of inducibility was present in both patients with paroxysmal (HR ¼ 2.38, P ¼ 0.001) and persistent AF (HR ¼ 1.91, P ¼ 0.034) and did not significantly differ between both ablation techniques. The sensitivity, specificity, positive, and negative predictive values of the AF induction test to predict the 6-month ablation outcome were 46.7, 75, 53.8, and 69.2%, respectively. Conclusion Inducibility of AF after ablation is a significant predictor of recurrent AF. However, owing to the low diagnostic accuracy of the AF induction test, non-inducibility does not qualify as reliable procedural endpoint.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…268,282,283,284,285,286,287,288,289,290,291,292,293,294,295,296,297,298 A recent meta-analysis identified 16 studies involving 5864 individuals reporting on the link between obesity and recurrence of AF after catheter ablation, identifying that there was a 3.1% greater risk of recurrent AF postablation for every one unit increase in BMI (RR 1.03; 95% CI 1.00–1.07). 299 …”

Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

“…Noninducibility of atrial tachyarrhythmia was defined if it terminated within 5 minutes. 16 The inducibility test was performed either after completion of PVI in patients with termination of atrial tachyarrhythmia or each time atrial tachyarrhythmia was terminated during additional post-PVI ablation in patients who experienced sustained atrial tachyarrhythmia after PVI. A stepwise procedure was applied to achieve noninducibility.…”

“…16,[19][20][21][22][23][24][25][26][27][28] Noninducibility of AF achieved by additional ablation after PVI is associated with lower AF recurrence compared with PVI alone. 23,24,28 However, Leong-Sit 29 et al reported that noninducibility of any atrial tachyarrhythmia is not predictive of clinical recurrence at a 1-year follow-up.…”

Inducibility of atrial fibrillation during electrophysiologic evaluation is associated with increased dispersion of atrial refractoriness

“…Patients with inducible AF are at an increased risk of AF recurrence, even after pulmonary vein isolation [8,9]. Atrial effective refractory periods (ERP) and its spatial dispersion heterogeneity have been accepted to promote AF re-initiation and to provide a substrate for the re-entry of multiple wavelets to enhance the ability of the disorder to sustaining itself [10,11].…”