Intraprocedural endpoints to predict durable pulmonary vein isolation: A randomized trial of four post-ablation techniques

Ruhong Jiang, Minglong Chen, Bing Yang, Qiang Liu, Zuwen Zhang, Fengxiang Zhang, Weizhu Ju, Mingfang Li, Xia Sheng, Yaxun Sun, Pei Zhang, Lu Yu, Shiquan Chen, Jun Zhu, Hui Cheng, Guosheng Fu, Roderick Tung, Chenyang Jiang

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Aims: The optimal procedural endpoint to achieve permanent pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) remains unknown. We aimed to compare the impact of prolonged waiting periods and adenosine triphosphate (ATP) testing after PVI on long-term freedom from AF. Methods and results: In total, 538 patients (median age 61 years, 62% male) undergoing first-time radiofrequency ablation for paroxysmal AF were randomized into four groups: Group 1 [PVI (no testing), n = 121], Group 2 (PVI + 30min waiting phase, n = 151), Group 3 (PVI+ATP, n = 131), and Group 4 (PVI + 30min+ATP, n = 135). The primary endpoint was freedom from AF. Repeat mapping to assess for late pulmonary vein (PV) reconnection was performed in patients who remained AF-free for >3 years (n = 46) and in those who had repeat ablation for AF recurrence (n = 82). During initial procedure, acute PV reconnection was observed in 33%, 26%, and 42% of patients in Groups 2, 3, and 4, respectively. At 36 months, no significant differences in freedom from AF recurrence were observed among all four groups (55%, 61%, 50%, and 62% for Groups 1, 2, 3, and 4, respectively; P = 0.258). Late PV reconnection was commonly observed, with a similar incidence between patients with and without AF recurrence (74% vs. 83%; P = 0.224). Conclusion: Although PVI remains the cornerstone for AF ablation, intraprocedural techniques to assess for PV reconnection did not improve long-term success. Patients without AF recurrence after 3 years exhibited similarly high rates of PV reconnection as those that underwent repeat ablation for AF recurrence. The therapeutic mechanisms of AF ablation may not be solely predicated upon durable PVI.

Original languageEnglish (US)
Pages (from-to)567-575
Number of pages9
JournalEuropace
Volume22
Issue number4
DOIs
StatePublished - Apr 1 2020
Externally publishedYes

Keywords

  • Adenosine triphosphate
  • Atrial fibrillation
  • Pulmonary vein isolation
  • Pulmonary vein reconnection
  • Recurrence
  • Waiting phase

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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