The efficacy of inducibility and circumferential ablation with pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Shih Lin Chang, Ching Tai Tai, Yenn Jiang Lin, Wanwarang Wongcharoen, Li Wei Lo, Ta Chuan Tuan, Ameya R. Udyavar, Sheng Hsiung Chang, Hsuan Ming Tsao, Ming Hsiung Hsieh, Yu Feng Hu, Yi Jen Chen, Shih Ann Chen

Research output: Contribution to journalArticle

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Abstract

Introduction: Some conflicting results of the efficacy of the inducibility test used in the catheter ablation of atrial fibrillation (AF) have been reported. The aim of this study was to investigate the inducibility and efficacy of circumferential ablation with pulmonary vein isolation (PVI) in patients with paroxysmal AF and its relationship to the atrial substrate. Methods and Results: This study consisted of 88 patients with paroxysmal AF who underwent catheter ablation. Electroanatomic mapping using a NavX system was performed and the biatrial voltage was obtained during sinus rhythm. After successful circumferential ablation with PVI, an inducibility test was performed to determine the requirement for creating left atrial (LA) ablation line. After procedure, patients with inducible AF had a higher recurrence rate than did those with noninducibility of AF (55% vs 18%, P = 0.02). The patients with inducible AF after the PVI had a lower biatrial voltage than did those with negative inducibility. The patients with inducible AF after the final procedure who had a recurrence had a lower LA voltage (1.3 ± 0.4 vs 1.8 ± 0.4 mV, P = 0.02) and longer LA total activation time (99 ± 18 vs 88 ± 13 msec, P = 0.02) than did those with noninducible AF and no recurrence. None of the patients had occurrence of LA flutter during the follow-up. Conclusion: After a single procedure of circumferential ablation with PVI and noninducibility, 82% patients did not have recurrence of AF. The inducibility of AF was related to the recurrence of AF. The atrial substrate affected the outcome of the inducibility.

Original languageEnglish
Pages (from-to)607-611
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume18
Issue number6
DOIs
Publication statusPublished - Jun 2007

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Patient Isolation
Pulmonary Veins
Atrial Fibrillation
Recurrence
Catheter Ablation
Atrial Flutter

Keywords

  • Electroanatomic mapping
  • Inducibility
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

The efficacy of inducibility and circumferential ablation with pulmonary vein isolation in patients with paroxysmal atrial fibrillation. / Chang, Shih Lin; Tai, Ching Tai; Lin, Yenn Jiang; Wongcharoen, Wanwarang; Lo, Li Wei; Tuan, Ta Chuan; Udyavar, Ameya R.; Chang, Sheng Hsiung; Tsao, Hsuan Ming; Hsieh, Ming Hsiung; Hu, Yu Feng; Chen, Yi Jen; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 18, No. 6, 06.2007, p. 607-611.

Research output: Contribution to journalArticle

Chang, Shih Lin ; Tai, Ching Tai ; Lin, Yenn Jiang ; Wongcharoen, Wanwarang ; Lo, Li Wei ; Tuan, Ta Chuan ; Udyavar, Ameya R. ; Chang, Sheng Hsiung ; Tsao, Hsuan Ming ; Hsieh, Ming Hsiung ; Hu, Yu Feng ; Chen, Yi Jen ; Chen, Shih Ann. / The efficacy of inducibility and circumferential ablation with pulmonary vein isolation in patients with paroxysmal atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2007 ; Vol. 18, No. 6. pp. 607-611.
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abstract = "Introduction: Some conflicting results of the efficacy of the inducibility test used in the catheter ablation of atrial fibrillation (AF) have been reported. The aim of this study was to investigate the inducibility and efficacy of circumferential ablation with pulmonary vein isolation (PVI) in patients with paroxysmal AF and its relationship to the atrial substrate. Methods and Results: This study consisted of 88 patients with paroxysmal AF who underwent catheter ablation. Electroanatomic mapping using a NavX system was performed and the biatrial voltage was obtained during sinus rhythm. After successful circumferential ablation with PVI, an inducibility test was performed to determine the requirement for creating left atrial (LA) ablation line. After procedure, patients with inducible AF had a higher recurrence rate than did those with noninducibility of AF (55{\%} vs 18{\%}, P = 0.02). The patients with inducible AF after the PVI had a lower biatrial voltage than did those with negative inducibility. The patients with inducible AF after the final procedure who had a recurrence had a lower LA voltage (1.3 ± 0.4 vs 1.8 ± 0.4 mV, P = 0.02) and longer LA total activation time (99 ± 18 vs 88 ± 13 msec, P = 0.02) than did those with noninducible AF and no recurrence. None of the patients had occurrence of LA flutter during the follow-up. Conclusion: After a single procedure of circumferential ablation with PVI and noninducibility, 82{\%} patients did not have recurrence of AF. The inducibility of AF was related to the recurrence of AF. The atrial substrate affected the outcome of the inducibility.",
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T1 - The efficacy of inducibility and circumferential ablation with pulmonary vein isolation in patients with paroxysmal atrial fibrillation

AU - Chang, Shih Lin

AU - Tai, Ching Tai

AU - Lin, Yenn Jiang

AU - Wongcharoen, Wanwarang

AU - Lo, Li Wei

AU - Tuan, Ta Chuan

AU - Udyavar, Ameya R.

AU - Chang, Sheng Hsiung

AU - Tsao, Hsuan Ming

AU - Hsieh, Ming Hsiung

AU - Hu, Yu Feng

AU - Chen, Yi Jen

AU - Chen, Shih Ann

PY - 2007/6

Y1 - 2007/6

N2 - Introduction: Some conflicting results of the efficacy of the inducibility test used in the catheter ablation of atrial fibrillation (AF) have been reported. The aim of this study was to investigate the inducibility and efficacy of circumferential ablation with pulmonary vein isolation (PVI) in patients with paroxysmal AF and its relationship to the atrial substrate. Methods and Results: This study consisted of 88 patients with paroxysmal AF who underwent catheter ablation. Electroanatomic mapping using a NavX system was performed and the biatrial voltage was obtained during sinus rhythm. After successful circumferential ablation with PVI, an inducibility test was performed to determine the requirement for creating left atrial (LA) ablation line. After procedure, patients with inducible AF had a higher recurrence rate than did those with noninducibility of AF (55% vs 18%, P = 0.02). The patients with inducible AF after the PVI had a lower biatrial voltage than did those with negative inducibility. The patients with inducible AF after the final procedure who had a recurrence had a lower LA voltage (1.3 ± 0.4 vs 1.8 ± 0.4 mV, P = 0.02) and longer LA total activation time (99 ± 18 vs 88 ± 13 msec, P = 0.02) than did those with noninducible AF and no recurrence. None of the patients had occurrence of LA flutter during the follow-up. Conclusion: After a single procedure of circumferential ablation with PVI and noninducibility, 82% patients did not have recurrence of AF. The inducibility of AF was related to the recurrence of AF. The atrial substrate affected the outcome of the inducibility.

AB - Introduction: Some conflicting results of the efficacy of the inducibility test used in the catheter ablation of atrial fibrillation (AF) have been reported. The aim of this study was to investigate the inducibility and efficacy of circumferential ablation with pulmonary vein isolation (PVI) in patients with paroxysmal AF and its relationship to the atrial substrate. Methods and Results: This study consisted of 88 patients with paroxysmal AF who underwent catheter ablation. Electroanatomic mapping using a NavX system was performed and the biatrial voltage was obtained during sinus rhythm. After successful circumferential ablation with PVI, an inducibility test was performed to determine the requirement for creating left atrial (LA) ablation line. After procedure, patients with inducible AF had a higher recurrence rate than did those with noninducibility of AF (55% vs 18%, P = 0.02). The patients with inducible AF after the PVI had a lower biatrial voltage than did those with negative inducibility. The patients with inducible AF after the final procedure who had a recurrence had a lower LA voltage (1.3 ± 0.4 vs 1.8 ± 0.4 mV, P = 0.02) and longer LA total activation time (99 ± 18 vs 88 ± 13 msec, P = 0.02) than did those with noninducible AF and no recurrence. None of the patients had occurrence of LA flutter during the follow-up. Conclusion: After a single procedure of circumferential ablation with PVI and noninducibility, 82% patients did not have recurrence of AF. The inducibility of AF was related to the recurrence of AF. The atrial substrate affected the outcome of the inducibility.

KW - Electroanatomic mapping

KW - Inducibility

KW - Pulmonary vein isolation

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DO - 10.1111/j.1540-8167.2007.00823.x

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