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. 2023 Jul 13:10:1115328.
doi: 10.3389/fcvm.2023.1115328. eCollection 2023.

Long-Term Follow-Up In Paroxysmal Atrial Fibrillation Patients With Documented Isolated Trigger

Zefferino Palamà  1   2 , Antonio Gianluca Robles  1   3 , Matteo Paoletti  1 , Martina Nesti  4 , Ermenegildo De Ruvo  5 , Antonio Scarà  6 , Alessio Borrelli  6 , Gabriele De Masi De Luca  1   7 , Mariano Rillo  2 , Leonardo Calò  5 , Elena Cavarretta  8   9 , Silvio Romano  1 , Luigi Sciarra  1
Affiliations

Long-Term Follow-Up In Paroxysmal Atrial Fibrillation Patients With Documented Isolated Trigger

Zefferino Palamà et al. Front Cardiovasc Med. .

Abstract

Aims: Supraventricular tachycardias may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences.

Methods and results: 249 patients (mean age: 54 ± 14 years) referred for paroxysmal AF ablation were studied. In all patients, only AF relapses had been documented in the clinical history. 47 patients (19%; mean age: 42 ± 11 years) had inducible SVT during the electrophysiological study and underwent an ablation targeted only at SVT suppression. Ablation was successful in all 47 patients. The ablative procedures were: 11 slow-pathway ablations for atrioventricular nodal re-entrant tachycardia; 6 concealed accessory pathway ablations for atrioventricular re-entrant tachycardia; 17 focal ectopic atrial tachycardia ablations; 13 with only one arrhythmogenic pulmonary vein. No recurrences of SVT were observed during the follow-up (32 ± 18 months). 4 patients (8.5%) showed recurrence of at least one episode of AF. Patients with inducible SVT had less structural heart disease and were younger than those without inducible SVT.

Conclusion: A significant proportion of candidates for AF ablation are inducible for an SVT. SVT ablation showed a preventive effect on AF recurrences. Those patients should be selected for simpler ablation procedures tailored only to the triggering arrhythmia suppression.

Keywords: PVI catheter ablation; PVI only; atrial fibrillation ablation; supraventricular tachycardia; tailored approach.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Graphic representation of the results obtained from the electrophysiological study in AF patients with documented trigger. In AVRNT group short RP interval during tachycardia in V1 lead as shown in ECG trace. In AVRT group (due to concealed Kent's bundle) long RP interval during tachycardia in II lead as shown in ECG trace. In FAT group “P on T” phenomena as shown in ECG trace. AVRNT, Atrioventricular nodal re-entrant tachycardia; AVRT, Atrioventricular re-entrant tachycardias; FAT, focal atrial tachycardia.
Figure 2
Figure 2
AF-free survival group in trigger ablation (blue line) and PVI-only (red line) patients of our study and in the control group (grey line) treated with a PVI-only approach without trigger research.
See this image and copyright information in PMC

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