Long-Term Clinical Comparison of Procedural End Points after Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation: Elimination of Nonpulmonary Vein Triggers Versus Noninducibility

Kwang No Lee, Seung Young Roh, Yong Soo Baek, Hee Soon Park, Jinhee Ahn, Dong Hyeok Kim, Dae In Lee, Jaemin Shim, Jongil Choi, Sang Weon Park, Young Hoon Kim

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. Methods and Results: A total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. Conclusions: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.

Original languageEnglish
Article numbere005019
JournalCirculation: Arrhythmia and Electrophysiology
Volume11
Issue number2
DOIs
Publication statusPublished - 2018 Feb 1

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Pulmonary Veins
Atrial Fibrillation
Veins
Tachycardia
Cardiac Electrophysiologic Techniques
Kaplan-Meier Estimate
Maintenance
Recurrence
Incidence

Keywords

  • atrial fibrillation
  • catheter ablation
  • incidence
  • recurrence
  • tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Long-Term Clinical Comparison of Procedural End Points after Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation : Elimination of Nonpulmonary Vein Triggers Versus Noninducibility. / Lee, Kwang No; Roh, Seung Young; Baek, Yong Soo; Park, Hee Soon; Ahn, Jinhee; Kim, Dong Hyeok; Lee, Dae In; Shim, Jaemin; Choi, Jongil; Park, Sang Weon; Kim, Young Hoon.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 11, No. 2, e005019, 01.02.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50{\%} to 75{\%} of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. Methods and Results: A total of 500 patients (mean age, 55.7±11.0 years; 74.6{\%} male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2{\%}) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8{\%}) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. Conclusions: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.",
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T2 - Elimination of Nonpulmonary Vein Triggers Versus Noninducibility

AU - Lee, Kwang No

AU - Roh, Seung Young

AU - Baek, Yong Soo

AU - Park, Hee Soon

AU - Ahn, Jinhee

AU - Kim, Dong Hyeok

AU - Lee, Dae In

AU - Shim, Jaemin

AU - Choi, Jongil

AU - Park, Sang Weon

AU - Kim, Young Hoon

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background: Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. Methods and Results: A total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. Conclusions: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.

AB - Background: Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. Methods and Results: A total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. Conclusions: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.

KW - atrial fibrillation

KW - catheter ablation

KW - incidence

KW - recurrence

KW - tachycardia

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