Lack of prognostic value of atrial arrhythmia inducibility and change in inducibility status after catheter ablation of atrial fibrillation

• Published in: Heart rhythm Vol. 15; no. 5; pp. 660 - 665
• Main Authors: Santangeli, Pasquale, Zado, Erica S., Garcia, Fermin C., Riley, Michael P., Lin, David, Frankel, David S., Supple, Gregory E., Schaller, Robert D., Dixit, Sanjay, Callans, David J., Marchlinski, Francis E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2018
• Subjects: Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial flutter; Atrial tachycardia; Catheter ablation; Catheter Ablation - methods; Electrophysiologic Techniques, Cardiac; Endosonography; Female; Follow-Up Studies; Heart Conduction System - physiopathology; Heart Conduction System - surgery; Humans; Male; Middle Aged; Nonpulmonary vein triggers; Outcome; Prognosis; Pulmonary vein isolation; Pulmonary Veins - diagnostic imaging; Pulmonary Veins - surgery; Recurrence; Retrospective Studies; Treatment Outcome; Atrial fibrillation; Catheter ablation; Outcome; Atrial tachycardia; Nonpulmonary vein triggers; Atrial flutter; Pulmonary vein isolation
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2017.10.023

Previous studies have suggested a role of atrial arrhythmia inducibility as an endpoint of catheter ablation of atrial fibrillation (AF). The prognostic value of noninducibility after ablation and of a change in inducibility status has not been investigated in large studies.
The purpose of this study was to evaluate the prognostic role of noninducibility and of a change in inducibility status after ablation of AF.
We studied 305 consecutive patients with AF (66% paroxysmal) undergoing antral pulmonary vein (PV) isolation plus non-PV triggers ablation. All patients underwent a standardized induction protocol before and after ablation from the coronary sinus and right atrium: 15-beat burst pacing at 250 ms and decrementing to 180 ms (up to 20 μg/min isoproterenol). Inducibility was defined as any sustained AF or organized atrial tachycardia (AT) lasting >2 minutes.
A total of 197 patients (65%) had inducible AF/AT at baseline compared to 118 (39%) after ablation. One hundred seven patients (57%) changed their inducibility status from inducible preablation to noninducible postablation. After 19 ± 7 months of follow-up, 212 patients (70%) remained free from any recurrent AF/AT. Noninducibility of AF/AT postablation (log-rank P = .236) or change in inducibility status (log-rank P = .429) was not associated with reduced risk of recurrent AF/AT. Results were consistent across the paroxysmal and nonparoxysmal subgroups.
Noninducibility of atrial arrhythmia or change in inducibility status after PV isolation and non-PV trigger ablation is not associated with long-term freedom from recurrent arrhythmia and should not be used as an ablation endpoint or to support the appropriateness of additional ablation lesion sets.