Is inducibility of atrial fibrillation after radio frequency ablation really a relevant prognostic factor?

• Published in: European heart journal Vol. 27; no. 21; pp. 2553 - 2559
• Main Authors: RICHTER, Bernhard, GWECHENBERGER, Marianne, FILZMOSER, Peter, MARX, Manfred, LERCHER, Peter, GÖSSINGER, Heinz D
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2006; Oxford Publishing Limited (England)
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - etiology; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - methods; Disease-Free Survival; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Pulmonary Veins - surgery; Secondary Prevention; Sensitivity and Specificity; Treatment Outcome; Prognosis; Arrhythmia; Atrial fibrillation; Catheter ablation; Catheter; Electrophysiology; Cardiovascular disease; Radio; Ablation; Phlebology; Excitability disorder; Heart disease; Frequency; Circulatory system; Cardiology; Inducibility
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl307

The study was intended to assess the prognostic value of inducibility of atrial fibrillation (AF) after radio frequency ablation. Two hundred and thirty four patients with drug-resistant paroxysmal (n=165) or persistent AF (n=69) underwent either Lasso-guided segmental pulmonary vein isolation (n=83) or CARTO-guided left atrial circumferential ablation (n=151). After ablation, two attempts to induce AF (>1 min) by decremental coronary sinus stimulation were performed. Patients were followed for at least 6 months (median: 12.7 months). At 6 months of follow-up, 67% of patients with paroxysmal and 48% of patients with persistent AF were AF-free. Inducibility of AF was a significant predictor of AF recurrence in univariate [hazard ratio (HR)=2.32, P<0.001] and multivariable (HR=2.19, P<0.001) Cox regression analyses. The prognostic value of inducibility was present in both patients with paroxysmal (HR=2.38, P=0.001) and persistent AF (HR=1.91, P=0.034) and did not significantly differ between both ablation techniques. The sensitivity, specificity, positive, and negative predictive values of the AF induction test to predict the 6-month ablation outcome were 46.7, 75, 53.8, and 69.2%, respectively. Inducibility of AF after ablation is a significant predictor of recurrent AF. However, owing to the low diagnostic accuracy of the AF induction test, non-inducibility does not qualify as reliable procedural endpoint.