Predictive value of noninducibility after catheter ablation for paroxysmal and persistent atrial fibrillation

Abstract

Background

It is unclear whether pacing maneuver at the end of catheter ablation for atrial fibrillation (AF) predicts recurrence of atrial tachyarrhythmia postintervention.

Objective

To investigate whether the predictive value of incremental pacing maneuver after catheter ablation for AF depends on the pacing cycle length and type of AF.

Methods

This study included 298 consecutive patients who underwent initial catheter ablation for nonvalvular AF (61% paroxysmal AF [PAF], 39% persistent AF [PeAF]). Rapid atrial pacing was performed at the end of the procedure. We analyzed minimum coupling interval (CI) of pacing, arrhythmia‐inducibility, and atrial tachyarrhythmia recurrence in patients with PAF and PeAF.

Results

Patients were divided into the following three groups according to their response to pacing maneuver: AF‐inducible (inducible group; n = 86), noninducible at CI ≥200 ms (non‐CI ≥200 group; n = 100), and noninducible at CI <200 ms (non‐CI <200 group; n = 112). Kaplan‐Meier analysis showed that response to pacing maneuver was significantly associated with recurrence of atrial tachyarrhythmias ( P = .028). Cox‐regression analysis showed that non‐CI <200 was an independent predictor when the inducible group was used as a reference (hazard ratio 0.60, 95% confidence interval 0.40‐0.96, P = .031). However, when PAF and PeAF were analyzed separately, non‐CI <200 was an independent predictor only in PeAF.

Conclusion

Noninducibility with shorter CI predicted atrial tachyarrhythmia recurrence only for PeAF. Pacing CI and type of AF could influence the predictive value of atrial tachyarrhythmia recurrence.

Abstract

When patients were divided into three groups according to the response to pacing maneuver (inducible, non‐inducible at coupling interval [CI] ≥ 200 ms, and non‐inducible at CI < 200 ms), significant difference in atrial tachyarrhythmia free survival were observed (panel A). However, when paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PeAF) were analyzed separately, significant deference was observed only in PeAF (panel B and C).