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European Heart Journal Advance Access originally published online on September 23, 2005
European Heart Journal 2005 26(23):2550-2555; doi:10.1093/eurheartj/ehi507
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Non-inducibility post-pulmonary vein isolation achieving exit block predicts freedom from atrial fibrillation

Vidal Essebag, Ferdinando Baldessin, Matthew R. Reynolds, Seth McClennen, Jignesh Shah, Kevin F. Kwaku, Peter Zimetbaum and Mark E. Josephson*

Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA

Received 21 June 2005; revised 10 August 2005; accepted 2 September 2005; online publish-ahead-of-print 23 September 2005.

* Corresponding author. Tel: +1 617 632 7393; fax: +1 617 632 7620. E-mail address: mjoseph2{at}bidmc.harvard.edu

See page 2484 for the editorial comment on this article (doi:10.1093/eurheartj/ehi577)

Aims This study evaluates whether non-inducibility of atrial fibrillation (AF) after achieving bi-directional electrical pulmonary vein (PV) isolation is a useful predictor of freedom from AF recurrence.

Methods and results This study included 102 consecutive patients who underwent PV isolation for symptomatic paroxysmal (59%), persistent (32%), or permanent (9%) AF. Patients were followed for 16±10 months. Complete isolation of all four PVs was confirmed by demonstration of bi-directional block, defined by both loss of PV potentials and failure to capture the LA by pacing (at 10 mA) 10–14 bipolar pairs of electrodes on a circumferential catheter positioned at the entrance of the PV. Induction of AF by burst pacing on/off isoproterenol was attempted after PV isolation. Freedom from recurrent symptomatic or asymptomatic AF was present in 70% of patients at 6 months and 62% of patients at 12 months. In multi-variable analysis, non-inducibility post-PV isolation (OR=3.84, P=0.047) and paroxysmal AF (OR=4.80, P=0.012) predicted freedom from AF at 12 months.

Conclusion Non-inducibility of AF after bi-directional PV isolation predicts maintenance of sinus rhythm. This finding suggests that routine extensive left atrial ablation may be unnecessary.

Key Words: Catheter ablation • Atrium • Fibrillation • Electrophysiology


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