Additional Ablation for Atrial Fibrillation Not Warranted After Change in Inducibility

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Neither paroxysmal nor nonparoxysmal AF benefited from additional ablation lesion sets after change in inducibility status.
Neither paroxysmal nor nonparoxysmal AF benefited from additional ablation lesion sets after change in inducibility status.

Change in inducibility status after pulmonary vein (PV) isolation and non-PV trigger ablation does not support the use of additional ablation lesion sets in patients with atrial fibrillation (AF), according to observational findings published in Heart Rhythm.

Investigators studied consecutive patients with AF who underwent antral PV isolation in addition to non-PV trigger ablation (n=305). Inducibility was defined as any organized tachycardia (AT) or sustained AF >2 minutes in duration.

At baseline, 65% (n=197) of patients had inducible AF/AT. In comparison, 39% (n=118) had inducible AF/AT after an ablation procedure. Approximately 57% (n=107) of patients included in this study experienced a change in inducibility status to noninducible after ablation.

Freedom from recurrent AF/AT events at follow-up (19±7 months) occurred in 70% (n=212) of patients. According to the investigators, change in inducibility status (log-rank P =.429) or noninducibility of postablation AF/AT (log-rank P =.236) did not correlate with a reduced risk for repeat AF/AT.

The observational nature of this study represents a potential limitation of the findings. In addition, the investigators evaluated only PV isolation and ablation of inducible non-PV triggers. Therefore, the researchers suggested that AF/AT noninducibility may result in better performance if other ablation strategies are used. Also, the study may be insufficiently powered to identify prognostic factors of AF/AT noninducibility.

The investigators stated that their findings do not currently support the "role of AF/AT inducibility and change in inducibility status to prognosticate arrhythmia-free survival following catheter ablation."

Reference

Santangeli P, Zado ES, Garcia FC, et al. Lack of prognostic value of atrial arrhythmia inducibility and change in inducibility status following catheter ablation of atrial fibrillation [published online October 19, 2017]. Heart Rhythm. doi:10.1016/j.hrthm.2017.10.023

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