Defibrillation threshold of internal cardioversion prior to ablation predicts atrial fibrillation recurrence

Abstract

Background Many studies have reported the predictors of atrial fibrillation (AF) recurrence after persistent AF (peAF) ablation. However, the correlation between the atrial defibrillation threshold (DFT) for internal cardioversion (IC) and AF recurrence rate is unknown. Here we investigated the relationship between the DFT prior to catheter ablation for peAF and AF recurrence. Hypothesis DFT prior to ablation was the predictive factor for AF recurrence after peAF ablation. Methods From June 2016 to May 2019, we enrolled 82 consecutive patients (mean age, 65.0 ± 12.4 years), including 45 with peAF and 37 with long‐standing peAF, at Hamamatsu Medical Center. To assess the DFT, we performed IC with gradually increasing energy prior to radiofrequency application. Results Forty‐nine and 33 patients showed DFT values less than or equal to 10 J (group A) and greater than 10 J or unsuccessful defibrillation (group B). During the mean follow‐up duration of 20.5 ± 13.1 months, patients in group B showed significantly higher AF recurrence rates than those in group A after the ablation procedure (p = .017). Multivariate analysis revealed that DFT was the only predictive factor for AF recurrence (odds ratio, 1.07; 95% CI, 1.00–1.13, p = .047). Conclusions The DFT for IC was among the strongest prognostic factors in the peAF ablation procedure.

Optimal patient selection for maze procedure in patients undergoing mitral valve disease

“…Intraoperative DC under complete left atrial and ventricular unloading by total cardiopulmonary bypass is a useful and effective method for selecting candidates for MAZE. Although few studies have investigated intraoperative DC before MAZE, several reports demonstrated that AF disappearance by DC before catheter ablation was a useful predictor of AF recurrence after catheter intervention [ 20 – 22 ]. Of our 12 patients who did not recover from intraoperative DC, we performed MAZE for 5 patients, even though NSR could not be restored by intraoperative DC because preoperative episodes of AF tachycardia were medically uncontrollable, and AF did not disappear in all patients.…”

Predictors of Atrial Fibrillation Recurrence after Ablation

“…Our study [21] enrolled 82 consecutive patients (mean age, 65.0 ± 12.4 years), including 45 with persistent AF and 37 with long-standing persistent AF. The recurrence rate after ablation was high among patients with long-standing persistent AF.…”