Atrial fibrillation inducibility after pulmonary vein isolation under general anaesthesia.

Tomas Skala,Martin Hutyra,Jan Precek,Ondrej Moravec,Jana Zapletalova,Milos Taborsky,Jitka Skalova,Zbynek Tudos,Olga Klementova

doi:10.5507/bp.2019.004

Tomas Skala, Martin Hutyra + Show 7 more

Open Access

https://doi.org/10.5507/bp.2019.004

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Abstract

Atrial fibrillation (AF) inducibility with rapid atrial pacing following AF ablation is associated with higher risk of AF recurrence. The predictive value of AF inducibility in paroxysmal AF patients after pulmonary vein isolation (PVI), done under general anaesthesia (GA), remains questionable since GA might alter AF inducibility and/or sustainability. Consecutive patients (n = 120) with paroxysmal AF without prior catheter ablation (CA) were enlisted in the study. All patients were ablated under GA. We have used a point-by-point CA and elimination of dormant conduction after adenosine in all patients. A predefined stimulation protocol was used to induce arrhythmias after PVI. Regular supraventricular tachycardias were mapped and ablated. Patients were divided into 3 subgroups - noninducible, inducible AF with spontaneous termination in five minutes, inducible AF without spontaneous termination. During 12 months of follow-up, all patients were examined four-times with 7-day ECG recordings. There was no statistical difference between the three subgroups in a rate of arrhythmia recurrence (11.1 vs. 27.5 vs. 27.3%, P=0.387), despite a clear trend to a better success rate in the non-inducible group. The subgroups did not differ in left atrial (LA) diameter (41.0±6, 43.0±7, 42.0±5 mm, P=0.962) or in any other baseline parameter. AF inducibility as well as presence or absence of its early spontaneous termination after PVI done under general anaesthesia in paroxysmal AF patients were not useful as predictors of procedural failure.

Highlights

The absence of atrial fibrillation (AF) inducibility with rapid atrial pacing following AF ablation is associated with a lower risk of AF recurrence[1]
Only limited data are available about AF inducibility after pulmonary vein isolation (PVI) under general anaesthesia (GA)
No major complications such as cardiac tamponade, stroke, atrio-esophageal fistula and/or pulmonary vein (PV) stenosis were documented in the study sample. 2 patients presented with a large groin hematoma prolonging the hospitalization for 2 and 3 days, respectively

Summary

Introduction

The absence of atrial fibrillation (AF) inducibility with rapid atrial pacing following AF ablation is associated with a lower risk of AF recurrence[1]. AF inducibility in paroxysmal AF patients has been used to guide further left atrial substrate modification[2,3]. In persistent and longstanding persistent AF, the generally accepted end-point is non-inducibility of any atrial tachyarrhythmia, since inducibility of any atrial tachyarrhythmia after ablation in these patients is linked to poor prognosis[4]. In paroxysmal AF, pulmonary vein isolation (PVI) is still the end-point of ablation. Despite recent technological improvements in PVI, single catheter ablation (CA) of paroxysmal AF consisting just of PVI, is rarely reported to have much higher success rate than 70% (ref.[5]). AF inducibility after PVI is considered to be linked to poor prognosis. The predictive value of AF inducibility in paroxysmal AF patients after PVI remains questionable. Only limited data are available about AF inducibility after PVI under general anaesthesia (GA). AF inducibility and presence of extra-pulmonary (nonPV) foci may be suppressed in GA (ref.[8,9,10])

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