Concomitant pulmonary vein isolation for induced atrial fibrillation to reduce future risk of atrial fibrillation after ablation for isolated atrial flutter

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-07-01 Epub Date: 2025-01-07 DOI:10.1016/j.hrthm.2024.12.047

Xuefeng Zhu MD , Kaixuan Fu MD , Chunxiao Wang MD , Mengmeng Ren MD , Wenjing Li MD , Hongxia Chu MD , Lin Zhong MD

{"title":"Concomitant pulmonary vein isolation for induced atrial fibrillation to reduce future risk of atrial fibrillation after ablation for isolated atrial flutter","authors":"Xuefeng Zhu MD , Kaixuan Fu MD , Chunxiao Wang MD , Mengmeng Ren MD , Wenjing Li MD , Hongxia Chu MD , Lin Zhong MD","doi":"10.1016/j.hrthm.2024.12.047","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>A significant proportion of patients with isolated atrial flutter will have atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation.</div></div><div><h3>Objective</h3><div>The aim of this study was to determine whether concomitant pulmonary vein isolation (PVI) could reduce the incidence of new-onset AF (NOAF) in the setting of inducible AF after CTI ablation.</div></div><div><h3>Methods</h3><div>A total of 275 consecutive patients with isolated atrial flutter who successfully underwent CTI ablation were included. Patients were stratified into the induced AF group (55 patients) and the noninduced AF group (220 patients) on the basis of the inducibility of AF. Subsequently, the induced AF group was randomly divided into a PVI group (28 patients) and non-PVI (27 patients) group.</div></div><div><h3>Results</h3><div>During 27.0 ± 6.0 months of follow-up, the PVI group (7.1% vs 51.9% [<em>P</em> < .001]; hazard ratio [HR], 0.103 [95% confidence interval for HR, 0.038–0.278; <em>P</em> < .001]) and noninduced AF group (13.2% vs 51.9% [<em>P</em> < .001]); HR, 0.207 [95% confidence interval for HR, 0.073–0.586; <em>P</em> < .001]) exhibited substantially lower incidence and risk of NOAF compared with the non-PVI group. Kaplan-Meier analysis showed that history of hypertension, cardiovascular disease, and heart failure and larger body mass index, larger left atrial diameter, and lower left ventricular ejection fraction were identified predictors of NOAF.</div></div><div><h3>Conclusion</h3><div>Inducibility of AF during CTI ablation is positively associated with an increased risk of NOAF, whereas concomitant PVI for induced AF can significantly reduce the incidence of NOAF.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 7","pages":"Pages e85-e91"},"PeriodicalIF":5.7000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1547527125000098","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/7 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

A significant proportion of patients with isolated atrial flutter will have atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation.

Objective

The aim of this study was to determine whether concomitant pulmonary vein isolation (PVI) could reduce the incidence of new-onset AF (NOAF) in the setting of inducible AF after CTI ablation.

Methods

A total of 275 consecutive patients with isolated atrial flutter who successfully underwent CTI ablation were included. Patients were stratified into the induced AF group (55 patients) and the noninduced AF group (220 patients) on the basis of the inducibility of AF. Subsequently, the induced AF group was randomly divided into a PVI group (28 patients) and non-PVI (27 patients) group.

Results

During 27.0 ± 6.0 months of follow-up, the PVI group (7.1% vs 51.9% [P < .001]; hazard ratio [HR], 0.103 [95% confidence interval for HR, 0.038–0.278; P < .001]) and noninduced AF group (13.2% vs 51.9% [P < .001]); HR, 0.207 [95% confidence interval for HR, 0.073–0.586; P < .001]) exhibited substantially lower incidence and risk of NOAF compared with the non-PVI group. Kaplan-Meier analysis showed that history of hypertension, cardiovascular disease, and heart failure and larger body mass index, larger left atrial diameter, and lower left ventricular ejection fraction were identified predictors of NOAF.

Conclusion

Inducibility of AF during CTI ablation is positively associated with an increased risk of NOAF, whereas concomitant PVI for induced AF can significantly reduce the incidence of NOAF.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

并发肺静脉隔离治疗诱发性心房颤动以降低孤立性心房扑动消融后心房颤动的未来风险。

背景：相当比例的孤立性心房扑动（AFL）患者在颈三尖瓣峡（CTI）消融后会发生心房颤动（AF）。目的：探讨合并肺静脉隔离（PVI）是否能降低诱导型心房颤动（CTI）消融后新发心房颤动（NOAF）的发生率。方法：共纳入275例连续成功行CTI消融的孤立性AFL患者。根据AF的诱导性将患者分为诱导性AF组（55例）和非诱导性AF组（220例），随后将诱导性AF组随机分为PVI组（28例）和非PVI组（27例）。结果：在27.0±6.0个月的随访中，PVI组（7.1% vs. 51.9%） [p]结论：CTI消融过程中诱发AF与NOAF的风险增加呈正相关，而PVI诱导AF可显著降低NOAF的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.