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European Heart Journal Advance Access originally published online on October 12, 2006
European Heart Journal 2006 27(21):2553-2559; doi:10.1093/eurheartj/ehl307
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Bernhard Richter1,*, Marianne Gwechenberger1, Peter Filzmoser2, Manfred Marx3, Peter Lercher1 and Heinz D. Gössinger1

1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
2 Department of Statistics and Probability Theory, Vienna University of Technology, Vienna, Austria
3 Department of Pediatrics, Medical University of Vienna, Vienna, Austria

Received 30 March 2006; revised 17 August 2006; accepted 21 September 2006; online publish-ahead-of-print 12 October 2006.

* Corresponding author. Tel: +43 1 40400 4614; fax: +43 1 408 11 48. E-mail address: bernhard.richter{at}meduniwien.ac.at

Aims The study was intended to assess the prognostic value of inducibility of atrial fibrillation (AF) after radio frequency ablation.

Methods and results 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.

Conclusion 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.

Key Words: Atrial fibrillation • Catheter ablation • Inducibility • Arrhythmia • Electrophysiology


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K. Satomi, R. Tilz, S. Takatsuki, J. Chun, B. Schmidt, D. Bansch, M. Antz, T. Zerm, A. Metzner, B. Kokturk, et al.
Inducibility of atrial tachyarrhythmias after circumferential pulmonary vein isolation in patients with paroxysmal atrial fibrillation: clinical predictor and outcome during follow-up
Europace, August 1, 2008; 10(8): 949 - 954.
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