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European Heart Journal Advance Access published online on September 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi507
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received June 21, 2005
Revised August 10, 2005
Accepted September 2, 2005

Clinical research

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

Vidal Essebag 1, Ferdinando Baldessin 1, Matthew R. Reynolds 1, Seth McClennen 1, Jignesh Shah 1, Kevin F. Kwaku 1, Peter Zimetbaum 1, and Mark E. Josephson 1*

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

* To whom correspondence should be addressed.
Mark E. Josephson, E-mail: mjoseph2{at}bidmc.harvard.edu


  Abstract

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.

Keywords: Catheter ablation; Atrium; Fibrillation; Electrophysiology.
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