Abstract
Background: Pulmonary vein isolation (PVI) is an effective strategy in the treatment of paroxysmal atrial fibrillation (PAF). Yet, there are limited data on additional ablation beyond PVI. In this study, we sought to assess the prevalence, predictors, and outcomes of additional ablation in PAF patients.Methods: A total of 537 consecutive patients with PAF were retrospectively evaluated for the index procedure. PVI was successfully conducted in all patients, after which electrophysiological study and drug provocation were performed, and additional ablations were delivered for concomitant arrhythmias, non-PV triggers, and low voltage zone (LVZ). The prevalence, predictors, and outcomes of additional ablation were analyzed.Results: Among 537 consecutive patients, 372 addition ablations were performed in 241 (44.88%) patients, including 252 (67.74%) concomitant arrhythmias in 198 (36.87%) patients, 56 (15.05%) non-PV triggers in 52 (9.68%) patients and 64 (17.20%) LVZ modification in 47 (8.75%) patients. Lower LVEF (OR = 0.937, p = 0.015), AF episode before procedure (OR = 2.990, p = 0.001), AF episode during procedure (OR = 1.998, p = 0.002) and AF episode induced after PVI (OR = 15.958, p < 0.001) were independent predictors of additional ablation. Single-procedure free from atrial arrhythmias at 58.36 ± 7.12 months post-ablation was 70.48%.Conclusions: Additional ablations were common in patients with PAF for index procedure. Lower LVEF and AF episodes before, during the procedure, and induced after PVI predicts additional ablation.
Highlights
Since Haissaguerre et al identified pulmonary veins (PVs) foci as major triggers of atrial fibrillation (AF) [1], pulmonary vein isolation (PVI) has been widely accepted as the basis of AF ablation procedures [2]
AF episodes before the procedure, AF episodes during the procedure, AF episodes needing direct current cardioversion (DCCV) and AF episode induced after PVI were documented in 54 (10.06%), 110 (20.48%), 47 (8.75%) patients, and 26 (4.84%) patients, respectively (Table 2)
Multi-variable logistic regression analysis revealed that lower left ventricular ejection fraction (LVEF) (OR = 0.937, p = 0.015), AF episode before the procedure (OR = 2.990, p = 0.001), AF episode during the procedure (OR = 1.998, p = 0.002) and AF episode induced after PVI (OR = 15.958, p < 0.001) were independent predictors for additional ablation (Supplemental Table 2)
Summary
Since Haissaguerre et al identified pulmonary veins (PVs) foci as major triggers of atrial fibrillation (AF) [1], pulmonary vein isolation (PVI) has been widely accepted as the basis of AF ablation procedures [2]. PVI in paroxysmal atrial fibrillation (PAF) patients has reached a success rate of 46–56% [3,4,5] after long follow-up. The PV foci are not always the only target, and PVI alone might not guarantee a long-term AF-free outcome in PAF patients. Addition ablations were mainly performed due to concomitant arrhythmias, non-PV triggers, and limited substrate modifications in PAF patients who underwent index procedure. We sought to assess the prevalence, predictors, and outcomes of additional ablation in PAF patients
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