Inducibility of atrial fibrillation and flutter following pulmonary vein ablation

Peter Leong-Sit, Melissa Robinson, Erica S. Zado, David J. Callans, Fermin Garcia, David Lin, Sanjay Dixit, Rupa Bala, Michael P. Riley, Mathew D. Hutchinson, Joshua Cooper, Edward P. Gerstenfeld, Francis E. Marchlinski

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Arrhythmia Inducibility Post-AF Ablation Introduction Prior reports demonstrate prognostic value in noninducibility of atrial arrhythmias after atrial fibrillation (AF) ablation and suggest their utility in guiding additional ablation lesion sets. The type and mechanism of induced atrial arrhythmias, their relationship to the underlying atrial substrate, and prognostic significance of induced organized atrial arrhythmias are unknown. Methods and Results One hundred forty-four patients (30 women; median age 60 years; 54% with paroxysmal AF) undergoing AF ablation (circumferential pulmonary vein isolation and focal ablation of nonvein triggers on isoproterenol) were evaluated prospectively. All underwent a standardized postablation induction protocol from the coronary sinus and right atrium: 15 beat burst pacing at 250 milliseconds and decrementing to 180 milliseconds. Sustained rhythms were defined as greater than 2 minutes Of 144 patients, 55 patients (38.2%) did not have sustained inducible arrhythmias. Fifty-two (36.1%) had inducible AF and 37 (25.7%) had inducible organized arrhythmias. A logistic regression analysis showed that age (OR 2.10 per decade; P = 0.003) and hypertension (OR 4.15; P = 0.009) were predictive of inducibility. However, inducibility of either AF or organized arrhythmias was not prognostic of clinical recurrence at 1 year postablation (P = 0.65). Furthermore, inducibility of organized arrhythmias did not predict clinical recurrence of an organized arrhythmia. Only LA size (OR 2.18; 95% CI 1.02-4.67; P = 0.04) and persistent AF (OR 2.43; 95% CI 1.09-5.40; P = 0.03) predicted atrial arrhythmia recurrence. Conclusions Multisite atrial burst pacing post-AF ablation induced organized rhythms in 25.7% and AF in 36.1% of patients after AF ablation. Hypertension and age predict inducibility of arrhythmias, but inducibility did not predict clinical recurrence in follow-up. Distinguishing organized atrial arrhythmias from AF did not yield any further prognostic information. The utility of aggressive stimulation protocols after AF ablation for prognosis and to guide therapy appears limited.

Original languageEnglish (US)
Pages (from-to)617-623
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume24
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Fingerprint

Atrial Flutter
Pulmonary Veins
Atrial Fibrillation
Cardiac Arrhythmias
Recurrence
Hypertension
Coronary Sinus
Heart Atria
Isoproterenol
Logistic Models
Regression Analysis

Keywords

  • atrial fibrillation
  • atrial tachyarrhythmias
  • catheter ablation
  • inducibility
  • prognosis
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Leong-Sit, P., Robinson, M., Zado, E. S., Callans, D. J., Garcia, F., Lin, D., ... Marchlinski, F. E. (2013). Inducibility of atrial fibrillation and flutter following pulmonary vein ablation. Journal of Cardiovascular Electrophysiology, 24(6), 617-623. https://doi.org/10.1111/jce.12088

Inducibility of atrial fibrillation and flutter following pulmonary vein ablation. / Leong-Sit, Peter; Robinson, Melissa; Zado, Erica S.; Callans, David J.; Garcia, Fermin; Lin, David; Dixit, Sanjay; Bala, Rupa; Riley, Michael P.; Hutchinson, Mathew D.; Cooper, Joshua; Gerstenfeld, Edward P.; Marchlinski, Francis E.

In: Journal of Cardiovascular Electrophysiology, Vol. 24, No. 6, 06.2013, p. 617-623.

Research output: Contribution to journalArticle

Leong-Sit, P, Robinson, M, Zado, ES, Callans, DJ, Garcia, F, Lin, D, Dixit, S, Bala, R, Riley, MP, Hutchinson, MD, Cooper, J, Gerstenfeld, EP & Marchlinski, FE 2013, 'Inducibility of atrial fibrillation and flutter following pulmonary vein ablation', Journal of Cardiovascular Electrophysiology, vol. 24, no. 6, pp. 617-623. https://doi.org/10.1111/jce.12088
Leong-Sit, Peter ; Robinson, Melissa ; Zado, Erica S. ; Callans, David J. ; Garcia, Fermin ; Lin, David ; Dixit, Sanjay ; Bala, Rupa ; Riley, Michael P. ; Hutchinson, Mathew D. ; Cooper, Joshua ; Gerstenfeld, Edward P. ; Marchlinski, Francis E. / Inducibility of atrial fibrillation and flutter following pulmonary vein ablation. In: Journal of Cardiovascular Electrophysiology. 2013 ; Vol. 24, No. 6. pp. 617-623.
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abstract = "Arrhythmia Inducibility Post-AF Ablation Introduction Prior reports demonstrate prognostic value in noninducibility of atrial arrhythmias after atrial fibrillation (AF) ablation and suggest their utility in guiding additional ablation lesion sets. The type and mechanism of induced atrial arrhythmias, their relationship to the underlying atrial substrate, and prognostic significance of induced organized atrial arrhythmias are unknown. Methods and Results One hundred forty-four patients (30 women; median age 60 years; 54{\%} with paroxysmal AF) undergoing AF ablation (circumferential pulmonary vein isolation and focal ablation of nonvein triggers on isoproterenol) were evaluated prospectively. All underwent a standardized postablation induction protocol from the coronary sinus and right atrium: 15 beat burst pacing at 250 milliseconds and decrementing to 180 milliseconds. Sustained rhythms were defined as greater than 2 minutes Of 144 patients, 55 patients (38.2{\%}) did not have sustained inducible arrhythmias. Fifty-two (36.1{\%}) had inducible AF and 37 (25.7{\%}) had inducible organized arrhythmias. A logistic regression analysis showed that age (OR 2.10 per decade; P = 0.003) and hypertension (OR 4.15; P = 0.009) were predictive of inducibility. However, inducibility of either AF or organized arrhythmias was not prognostic of clinical recurrence at 1 year postablation (P = 0.65). Furthermore, inducibility of organized arrhythmias did not predict clinical recurrence of an organized arrhythmia. Only LA size (OR 2.18; 95{\%} CI 1.02-4.67; P = 0.04) and persistent AF (OR 2.43; 95{\%} CI 1.09-5.40; P = 0.03) predicted atrial arrhythmia recurrence. Conclusions Multisite atrial burst pacing post-AF ablation induced organized rhythms in 25.7{\%} and AF in 36.1{\%} of patients after AF ablation. Hypertension and age predict inducibility of arrhythmias, but inducibility did not predict clinical recurrence in follow-up. Distinguishing organized atrial arrhythmias from AF did not yield any further prognostic information. The utility of aggressive stimulation protocols after AF ablation for prognosis and to guide therapy appears limited.",
keywords = "atrial fibrillation, atrial tachyarrhythmias, catheter ablation, inducibility, prognosis, pulmonary vein isolation",
author = "Peter Leong-Sit and Melissa Robinson and Zado, {Erica S.} and Callans, {David J.} and Fermin Garcia and David Lin and Sanjay Dixit and Rupa Bala and Riley, {Michael P.} and Hutchinson, {Mathew D.} and Joshua Cooper and Gerstenfeld, {Edward P.} and Marchlinski, {Francis E.}",
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T1 - Inducibility of atrial fibrillation and flutter following pulmonary vein ablation

AU - Leong-Sit, Peter

AU - Robinson, Melissa

AU - Zado, Erica S.

AU - Callans, David J.

AU - Garcia, Fermin

AU - Lin, David

AU - Dixit, Sanjay

AU - Bala, Rupa

AU - Riley, Michael P.

AU - Hutchinson, Mathew D.

AU - Cooper, Joshua

AU - Gerstenfeld, Edward P.

AU - Marchlinski, Francis E.

PY - 2013/6

Y1 - 2013/6

N2 - Arrhythmia Inducibility Post-AF Ablation Introduction Prior reports demonstrate prognostic value in noninducibility of atrial arrhythmias after atrial fibrillation (AF) ablation and suggest their utility in guiding additional ablation lesion sets. The type and mechanism of induced atrial arrhythmias, their relationship to the underlying atrial substrate, and prognostic significance of induced organized atrial arrhythmias are unknown. Methods and Results One hundred forty-four patients (30 women; median age 60 years; 54% with paroxysmal AF) undergoing AF ablation (circumferential pulmonary vein isolation and focal ablation of nonvein triggers on isoproterenol) were evaluated prospectively. All underwent a standardized postablation induction protocol from the coronary sinus and right atrium: 15 beat burst pacing at 250 milliseconds and decrementing to 180 milliseconds. Sustained rhythms were defined as greater than 2 minutes Of 144 patients, 55 patients (38.2%) did not have sustained inducible arrhythmias. Fifty-two (36.1%) had inducible AF and 37 (25.7%) had inducible organized arrhythmias. A logistic regression analysis showed that age (OR 2.10 per decade; P = 0.003) and hypertension (OR 4.15; P = 0.009) were predictive of inducibility. However, inducibility of either AF or organized arrhythmias was not prognostic of clinical recurrence at 1 year postablation (P = 0.65). Furthermore, inducibility of organized arrhythmias did not predict clinical recurrence of an organized arrhythmia. Only LA size (OR 2.18; 95% CI 1.02-4.67; P = 0.04) and persistent AF (OR 2.43; 95% CI 1.09-5.40; P = 0.03) predicted atrial arrhythmia recurrence. Conclusions Multisite atrial burst pacing post-AF ablation induced organized rhythms in 25.7% and AF in 36.1% of patients after AF ablation. Hypertension and age predict inducibility of arrhythmias, but inducibility did not predict clinical recurrence in follow-up. Distinguishing organized atrial arrhythmias from AF did not yield any further prognostic information. The utility of aggressive stimulation protocols after AF ablation for prognosis and to guide therapy appears limited.

AB - Arrhythmia Inducibility Post-AF Ablation Introduction Prior reports demonstrate prognostic value in noninducibility of atrial arrhythmias after atrial fibrillation (AF) ablation and suggest their utility in guiding additional ablation lesion sets. The type and mechanism of induced atrial arrhythmias, their relationship to the underlying atrial substrate, and prognostic significance of induced organized atrial arrhythmias are unknown. Methods and Results One hundred forty-four patients (30 women; median age 60 years; 54% with paroxysmal AF) undergoing AF ablation (circumferential pulmonary vein isolation and focal ablation of nonvein triggers on isoproterenol) were evaluated prospectively. All underwent a standardized postablation induction protocol from the coronary sinus and right atrium: 15 beat burst pacing at 250 milliseconds and decrementing to 180 milliseconds. Sustained rhythms were defined as greater than 2 minutes Of 144 patients, 55 patients (38.2%) did not have sustained inducible arrhythmias. Fifty-two (36.1%) had inducible AF and 37 (25.7%) had inducible organized arrhythmias. A logistic regression analysis showed that age (OR 2.10 per decade; P = 0.003) and hypertension (OR 4.15; P = 0.009) were predictive of inducibility. However, inducibility of either AF or organized arrhythmias was not prognostic of clinical recurrence at 1 year postablation (P = 0.65). Furthermore, inducibility of organized arrhythmias did not predict clinical recurrence of an organized arrhythmia. Only LA size (OR 2.18; 95% CI 1.02-4.67; P = 0.04) and persistent AF (OR 2.43; 95% CI 1.09-5.40; P = 0.03) predicted atrial arrhythmia recurrence. Conclusions Multisite atrial burst pacing post-AF ablation induced organized rhythms in 25.7% and AF in 36.1% of patients after AF ablation. Hypertension and age predict inducibility of arrhythmias, but inducibility did not predict clinical recurrence in follow-up. Distinguishing organized atrial arrhythmias from AF did not yield any further prognostic information. The utility of aggressive stimulation protocols after AF ablation for prognosis and to guide therapy appears limited.

KW - atrial fibrillation

KW - atrial tachyarrhythmias

KW - catheter ablation

KW - inducibility

KW - prognosis

KW - pulmonary vein isolation

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