Impact of diagnosis‐to‐ablation time on non‐pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation

Introduction Non‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis‐to‐ablation time (DAT) on non‐PV triggers in persistent atrial fibrillation is unknown. Methods and Results This observational stud...

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Published in:Journal of cardiovascular electrophysiology Vol. 32; no. 5; pp. 1251 - 1258
Main Authors: Takamiya, Tomomasa, Nitta, Junichi, Inaba, Osamu, Sato, Akira, Inamura, Yukihiro, Murata, Kazuya, Ikenouchi, Takashi, Kono, Toshikazu, Takahashi, Yoshihide, Goya, Masahiko, Sasano, Tetsuo
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01.05.2021
Subjects:
Ablation
atrial fibrillation
Cardiac arrhythmia
catheter ablation
Catheters
Diagnosis
diagnosis‐to‐ablation time
duration
Fibrillation
Multivariate analysis
non‐pulmonary vein foci
non‐pulmonary vein triggers
posterior wall isolation
Sex ratio
Tachyarrhythmia
duration
posterior wall isolation
atrial fibrillation
catheter ablation
diagnosis-to-ablation time
non-pulmonary vein foci
non-pulmonary vein triggers
ISSN:1045-3873, 1540-8167, 1540-8167
Online Access:Get full text
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Summary:Introduction Non‐pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosis‐to‐ablation time (DAT) on non‐PV triggers in persistent atrial fibrillation is unknown. Methods and Results This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non‐PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non‐PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow‐up of 770 days, the ATA recurrence‐free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year, p = .008) were predictors of non‐PV AF/AT triggers, and a longer DAT (hazard ratio: 1.12/year, p < .001) and non‐PV AT/AF triggers (hazard ratio: 1.79, p = .009) were associated with ATA recurrence. Conclusion Early ablation after the first diagnosis of persistent AF may reduce emerging non‐PV AF/AT triggers and ATA recurrence.
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ISSN:1045-3873
1540-8167
1540-8167
DOI:10.1111/jce.15002