Predictive value of the induction test with atrial burst pacing with regard to long-term recurrence after ablation in persistent atrial fibrillation

Shunsuke Kawai, Yasushi Mukai, Shujiro Inoue, Daisuke Yakabe, Kazuhiro Nagaoka, Kazuo Sakamoto, Susumu Takase, Akiko Chishaki, Hiroyuki Tsutsui

Research output: Contribution to journalArticle

Abstract

Background: Induction test of atrial fibrillation (AF) is one of endpoint measures in catheter ablation (CA). However, its predictive value in long-term outcome remains controversial. Methods: Ninety-eight patients (61 years, 77 males) with persistent AF who underwent pulmonary vein antrum isolation-based CA were retrospectively analyzed. We determined whether inducibility of AF/atrial tachyarrhythmias (AT) by atrial burst pacing at the end of CA and other characteristics were associated with the recurrence of AF/AT. Atrial burst pacing was performed with 30-beat from the coronary sinus; increasing from 240 to 320 ppm. Inducibility was defined as AF/AT lasting ≥5 minutes following atrial burst pacing. Results: AF/AT was induced in 50 patients (51%). During 1 year of follow-up, 71 patients (72.4%) had no recurrence of AF/AT. A logistic regression analysis showed that female gender (OR 3.8; P = 0.02), multiple sessions (OR 3.5; P = 0.02), and early recurrence of AF/AT (OR 5.3; P = 0.004) were associated with clinical recurrence. AF/AT Inducibility was not associated with clinical recurrence (P = 0.65). A subanalysis in patients with enlarged LA (LA diameter ≥45 mm, n = 40) showed that AF/AT inducibility was associated with recurrence (OR 8.1; P = 0.04). The positive and negative predictive values of AF/AT inducibility for AF/AT recurrence were 41 and 89%, respectively. Negative predictive value was increased to 92.3% when the inducibility was defined as AF/AT of ≥30 seconds following atrial burst pacing. Conclusions: AF/AT inducibility cannot predict long-term clinical recurrence in patients with persistent AF. However, it may have a prognostic value especially in patients with enlarged LA.

Original languageEnglish
Journaljournal of arrhythmia
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Predictive Value of Tests
Atrial Fibrillation
Tachycardia
Recurrence
Catheter Ablation
Coronary Sinus
Pulmonary Veins

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Predictive value of the induction test with atrial burst pacing with regard to long-term recurrence after ablation in persistent atrial fibrillation. / Kawai, Shunsuke; Mukai, Yasushi; Inoue, Shujiro; Yakabe, Daisuke; Nagaoka, Kazuhiro; Sakamoto, Kazuo; Takase, Susumu; Chishaki, Akiko; Tsutsui, Hiroyuki.

In: journal of arrhythmia, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Predictive value of the induction test with atrial burst pacing with regard to long-term recurrence after ablation in persistent atrial fibrillation",
abstract = "Background: Induction test of atrial fibrillation (AF) is one of endpoint measures in catheter ablation (CA). However, its predictive value in long-term outcome remains controversial. Methods: Ninety-eight patients (61 years, 77 males) with persistent AF who underwent pulmonary vein antrum isolation-based CA were retrospectively analyzed. We determined whether inducibility of AF/atrial tachyarrhythmias (AT) by atrial burst pacing at the end of CA and other characteristics were associated with the recurrence of AF/AT. Atrial burst pacing was performed with 30-beat from the coronary sinus; increasing from 240 to 320 ppm. Inducibility was defined as AF/AT lasting ≥5 minutes following atrial burst pacing. Results: AF/AT was induced in 50 patients (51{\%}). During 1 year of follow-up, 71 patients (72.4{\%}) had no recurrence of AF/AT. A logistic regression analysis showed that female gender (OR 3.8; P = 0.02), multiple sessions (OR 3.5; P = 0.02), and early recurrence of AF/AT (OR 5.3; P = 0.004) were associated with clinical recurrence. AF/AT Inducibility was not associated with clinical recurrence (P = 0.65). A subanalysis in patients with enlarged LA (LA diameter ≥45 mm, n = 40) showed that AF/AT inducibility was associated with recurrence (OR 8.1; P = 0.04). The positive and negative predictive values of AF/AT inducibility for AF/AT recurrence were 41 and 89{\%}, respectively. Negative predictive value was increased to 92.3{\%} when the inducibility was defined as AF/AT of ≥30 seconds following atrial burst pacing. Conclusions: AF/AT inducibility cannot predict long-term clinical recurrence in patients with persistent AF. However, it may have a prognostic value especially in patients with enlarged LA.",
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T1 - Predictive value of the induction test with atrial burst pacing with regard to long-term recurrence after ablation in persistent atrial fibrillation

AU - Kawai, Shunsuke

AU - Mukai, Yasushi

AU - Inoue, Shujiro

AU - Yakabe, Daisuke

AU - Nagaoka, Kazuhiro

AU - Sakamoto, Kazuo

AU - Takase, Susumu

AU - Chishaki, Akiko

AU - Tsutsui, Hiroyuki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Induction test of atrial fibrillation (AF) is one of endpoint measures in catheter ablation (CA). However, its predictive value in long-term outcome remains controversial. Methods: Ninety-eight patients (61 years, 77 males) with persistent AF who underwent pulmonary vein antrum isolation-based CA were retrospectively analyzed. We determined whether inducibility of AF/atrial tachyarrhythmias (AT) by atrial burst pacing at the end of CA and other characteristics were associated with the recurrence of AF/AT. Atrial burst pacing was performed with 30-beat from the coronary sinus; increasing from 240 to 320 ppm. Inducibility was defined as AF/AT lasting ≥5 minutes following atrial burst pacing. Results: AF/AT was induced in 50 patients (51%). During 1 year of follow-up, 71 patients (72.4%) had no recurrence of AF/AT. A logistic regression analysis showed that female gender (OR 3.8; P = 0.02), multiple sessions (OR 3.5; P = 0.02), and early recurrence of AF/AT (OR 5.3; P = 0.004) were associated with clinical recurrence. AF/AT Inducibility was not associated with clinical recurrence (P = 0.65). A subanalysis in patients with enlarged LA (LA diameter ≥45 mm, n = 40) showed that AF/AT inducibility was associated with recurrence (OR 8.1; P = 0.04). The positive and negative predictive values of AF/AT inducibility for AF/AT recurrence were 41 and 89%, respectively. Negative predictive value was increased to 92.3% when the inducibility was defined as AF/AT of ≥30 seconds following atrial burst pacing. Conclusions: AF/AT inducibility cannot predict long-term clinical recurrence in patients with persistent AF. However, it may have a prognostic value especially in patients with enlarged LA.

AB - Background: Induction test of atrial fibrillation (AF) is one of endpoint measures in catheter ablation (CA). However, its predictive value in long-term outcome remains controversial. Methods: Ninety-eight patients (61 years, 77 males) with persistent AF who underwent pulmonary vein antrum isolation-based CA were retrospectively analyzed. We determined whether inducibility of AF/atrial tachyarrhythmias (AT) by atrial burst pacing at the end of CA and other characteristics were associated with the recurrence of AF/AT. Atrial burst pacing was performed with 30-beat from the coronary sinus; increasing from 240 to 320 ppm. Inducibility was defined as AF/AT lasting ≥5 minutes following atrial burst pacing. Results: AF/AT was induced in 50 patients (51%). During 1 year of follow-up, 71 patients (72.4%) had no recurrence of AF/AT. A logistic regression analysis showed that female gender (OR 3.8; P = 0.02), multiple sessions (OR 3.5; P = 0.02), and early recurrence of AF/AT (OR 5.3; P = 0.004) were associated with clinical recurrence. AF/AT Inducibility was not associated with clinical recurrence (P = 0.65). A subanalysis in patients with enlarged LA (LA diameter ≥45 mm, n = 40) showed that AF/AT inducibility was associated with recurrence (OR 8.1; P = 0.04). The positive and negative predictive values of AF/AT inducibility for AF/AT recurrence were 41 and 89%, respectively. Negative predictive value was increased to 92.3% when the inducibility was defined as AF/AT of ≥30 seconds following atrial burst pacing. Conclusions: AF/AT inducibility cannot predict long-term clinical recurrence in patients with persistent AF. However, it may have a prognostic value especially in patients with enlarged LA.

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