Outcomes After Atrial Fibrillation Ablation in Patients With Premature Atrial Contractions Originating From Non-Pulmonary Veins.
atrial fibrillation
catheter ablation
non-pulmonary vein
premature atrial contractions
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
11
02
2019
revised:
29
07
2019
accepted:
06
08
2019
entrez:
23
11
2019
pubmed:
23
11
2019
medline:
21
10
2020
Statut:
ppublish
Résumé
The aim of this study was to examine the relationship between residual premature atrial contractions (PACs) originating from non-pulmonary veins (PVs), which do not initiate atrial fibrillation (AF), and AF recurrence after ablation. Residual atrial ectopic beats that trigger AF from non-PVs (non-PV AF triggers) after catheter ablation are among the major causes of AF recurrence. However, little is known about the impact of non-PV PACs on AF recurrence. This retrospective study included 565 consecutive patients who underwent first-time AF ablation at our institution. After PV isolation, we infused isoproterenol to provoke non-PV AF triggers and/or non-PV PACs. We excluded 26 patients with non-PV AF triggers and 3 patients who underwent ablation of non-PV PACs, and finally analyzed 536 patients. Non-PV PACs were defined as ectopic beats that were constantly observed with the same intra-atrial activation patterns from non-PVs. Residual non-PV PACs during the procedure were observed in 112 patients (21%). There was no significant difference in the AF recurrence rate between patients with non-PV PACs (35 of 112, 31%) and those without (145 of 424, 34%; log-rank p = 0.69), during a median follow-up of 670 days. Age- and sex-adjusted hazards for AF recurrence were also similar between the 2 groups. The similar AF recurrence rate in patients with and without non-PV PACs suggests that the additional ablation of non-PV PACs has limited effect on AF recurrence.
Sections du résumé
OBJECTIVES
The aim of this study was to examine the relationship between residual premature atrial contractions (PACs) originating from non-pulmonary veins (PVs), which do not initiate atrial fibrillation (AF), and AF recurrence after ablation.
BACKGROUND
Residual atrial ectopic beats that trigger AF from non-PVs (non-PV AF triggers) after catheter ablation are among the major causes of AF recurrence. However, little is known about the impact of non-PV PACs on AF recurrence.
METHODS
This retrospective study included 565 consecutive patients who underwent first-time AF ablation at our institution. After PV isolation, we infused isoproterenol to provoke non-PV AF triggers and/or non-PV PACs. We excluded 26 patients with non-PV AF triggers and 3 patients who underwent ablation of non-PV PACs, and finally analyzed 536 patients. Non-PV PACs were defined as ectopic beats that were constantly observed with the same intra-atrial activation patterns from non-PVs.
RESULTS
Residual non-PV PACs during the procedure were observed in 112 patients (21%). There was no significant difference in the AF recurrence rate between patients with non-PV PACs (35 of 112, 31%) and those without (145 of 424, 34%; log-rank p = 0.69), during a median follow-up of 670 days. Age- and sex-adjusted hazards for AF recurrence were also similar between the 2 groups.
CONCLUSIONS
The similar AF recurrence rate in patients with and without non-PV PACs suggests that the additional ablation of non-PV PACs has limited effect on AF recurrence.
Identifiants
pubmed: 31753439
pii: S2405-500X(19)30566-3
doi: 10.1016/j.jacep.2019.08.002
pii:
doi:
Substances chimiques
Adrenergic beta-Agonists
0
Isoproterenol
L628TT009W
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1319-1327Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.