Atrial tachycardia occurrence during catheter ablation in persistent AF patients with low-voltage areas was independently associated with subsequent recurrence (HR 1.94; 95% CI 1.15-3.10; p=0.014).
RCT (n=339)
Does the occurrence of atrial tachycardia during catheter ablation predict post-ablation recurrence in patients with persistent atrial fibrillation and low-voltage areas?
The occurrence of atrial tachycardia during catheter ablation for persistent AF with low-voltage areas is an independent predictor of post-ablation arrhythmia recurrence.
Effect estimate: HR 1.94 (95% CI 1.15-3.10)
Absolute Event Rate: 52.6% vs 36.5%
p-value: p=0.014
Abstract Background Low voltage areas (LVAs) can serve as substrates for slow conduction, potentially leading to the induction of atrial tachycardia (AT) during atrial fibrillation (AF) ablation. However, patient characteristics associated with AT occurrence and its impact on post-ablation recurrence remain unclear. Purpose This study aimed to identify patient characteristics associated with AT occurrence during initial catheter ablation and evaluates its impact on post-ablation recurrence in persistent AF patients with LVAs. Methods An analysis was performed from the SUPPRESS-AF trial, a randomized controlled trial that investigated the efficacy and safety of LVA ablation in patients with persistent AF and LVAs. AT was induced by burst pacing after pulmonary vein isolation with or without LVA ablation. All induced ATs were ablated until non-inducibility. Results Of 339 study patients, 48 ATs (9 peri-mitral flutters, 6 roof-dependent ATs, 33 other ATs) were induced and ablated in 38 (11.2%) patients. Patients with induced ATs were more likely to be female (73.7% vs. 46.2%, p=0.001), had larger LVAs (20.8 vs. 12.8 cm2, p0.001), and more frequently underwent LVA ablation (68.4% vs. 47.2%, p=0.014) than those without induced ATs. Despite a high success rate of AT ablation (78.9%; 30/38 patients), subsequent AF/AT recurrence rates were significantly higher in patients with induced AT compared to those without (52.6% vs. 36.5%, log-rank p=0.040) (Figure). Multivariate Cox regression analysis revealed that AT occurrence was independently associated with subsequent recurrence after adjusting for age, sex, left atrial diameter, the extent of LVAs, non-PV trigger ablation, and LVA ablation (hazard ratio, 1.94; 95% confidence interval, 1.15–3.10; p=0.014) (Table). Conclusions In persistent AF patients with LVAs, AT was more frequently induced in females, those with larger LVAs, and those undergoing LVA ablation. AT occurrence was an independent predictor of post-ablation recurrence.Kaplan-Meier curve Multivariate Cox regression analysis
Iwasa et al. (Sat,) conducted a rct in Persistent atrial fibrillation with low-voltage areas (n=339). Induced atrial tachycardia during ablation vs. No induced atrial tachycardia was evaluated on Subsequent AF/AT recurrence (HR 1.94, 95% CI 1.15-3.10, p=0.014). Atrial tachycardia occurrence during catheter ablation in persistent AF patients with low-voltage areas was independently associated with subsequent recurrence (HR 1.94; 95% CI 1.15-3.10; p=0.014).