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Impact of diagnosis‐to‐ablation time on non‐pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation
Author(s) -
Takamiya Tomomasa,
Nitta Junichi,
Inaba Osamu,
Sato Akira,
Inamura Yukihiro,
Murata Kazuya,
Ikenouchi Takashi,
Kono Toshikazu,
Takahashi Yoshihide,
Goya Masahiko,
Sasano Tetsuo
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.15002
Subject(s) - medicine , atrial fibrillation , pulmonary vein , hazard ratio , cardiology , ablation , catheter ablation , odds ratio , sinus rhythm , coronary sinus , confidence interval
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.