Importance of non-pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction

Yonghui Zhao, Luigi Di Biase, Chintan Trivedi, Sanghamitra Mohanty, Rong Bai, Prasant Mohanty, Carola Gianni, Pasquale Santangeli, Rodney Horton, Javier Sanchez, G. Joseph Gallinghouse, Jason Zagrodzky, Richard Hongo, Salwa Beheiry, Dhanunjaya Lakkireddy, Madhu Reddy, Patrick Hranitzky, Amin Al-Ahmad, Claude Elayi, J. David BurkhardtAndrea Natale

Research output: Contribution to journalArticle

56 Scopus citations

Abstract

Background Whether ablation of non-pulmonary vein (PV) triggers after pulmonary vein antrum isolation (PVAI) improves the long-term procedure outcome in patients with paroxysmal atrial fibrillation (PAF) and left ventricular systolic dysfunction is unknown. Objective We sought to evaluate whether a more extensive ablation procedure improves outcomes at follow-up. Methods Consecutive patients with PAF refractory to antiarrhythmic drugs presenting for PVAI were prospectively studied. Patients were categorized into 2 groups: patients with left ventricular ejection fraction (LVEF) ≤35% (group I; n = 175) and patients with LVEF ≥50% (group II; n = 545). Patients in group I were further divided according to whether additional ablation of non-PV triggers was performed (group IA; n = 88) or not (group IB; n = 87). Long-term ablation success off antiarrhythmic drugs after a single procedure was analyzed. Results Patients in group I had more non-PV triggers than did patients in group II (69.1% vs 26.6%; P <.001). During a follow-up of 15.8 ± 4.7 months, fewer patients in group I remained free from recurrences than those in group II (53.7% vs 81.7%; P <.001). Long-term ablation success was higher in group IA than in group IB (75.0% vs 32.2%; P <.001) and similar to that in group II (75.0% vs 81.7%; P =.44). In multivariate analysis, LVEF ≤35% (hazard ratio 1.68; P =.003) and non-PV triggers (hazard ratio 3.12; P <.001) were independent predictors of recurrences. Conclusion In patients with PAF and left ventricular systolic dysfunction, ablation of non-PV triggers in addition to PVAI significantly improves their long-term procedure outcome.

Original languageEnglish (US)
Pages (from-to)141-149
Number of pages9
JournalHeart Rhythm
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Ejection fraction
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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