Influence of underlying substrate on atrial tachyarrhythmias after pulmonary vein isolation

FACM patients are a challenging AF subgroup for catheter ablation. Women seem to show FACM III+IV more often than men. The distribution of left atrial fibrosis is variable but more pronounced anteriorly. Atrial disease is characterized by SFA size but also maximum voltage reduction, both with implications on ablation outcome. Using BIFA, success rates of patients without fibrosis can be approached but are limited in FACM III+IV.

Section: Discussionmentioning

confidence: 54%

“…Therefore, understanding and targeting an existing atrial substrate that contributes to the maintenance of AF is a new strategy to improve success rates of catheter ablation. Electroanatomic voltage mapping (EAVM) is an established intraprocedural tool to detect fibrosis .…”

Section: Introductionmentioning

confidence: 99%

Catheter ablation of atrial fibrillation with box isolation of fibrotic areas: Lessons on fibrosis distribution and extent, clinical characteristics, and their impact on long‐term outcome

Schreiber

Rieger

Moser

et al. 2017

“…In addition, we included only patients with paroxysmal AF, allowing for more clear conclusions regarding the relation between atrial structural remodeling and AF recurrence after PVAI. Previous studies have characterized the LA substrate with electroanatomical mapping, but with only 54–158 points …”

Section: Discussionmentioning

confidence: 99%

“…However, both DE‐MRI and low‐density electroanatomic substrate mapping have important limitations in left atrium (LA) imaging. Previous studies reported electroanatomical mapping of the left atrium using 54–158 points . We hypothesized that high‐density electroanatomic mapping using > 2,000 points may allow detailed LA substrate characterization.…”

Section: Introductionmentioning

confidence: 99%

Low‐voltage areas detected by high‐density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation

Vlachos

Efremidis

Letsas

et al. 2017

“…Kawai et al 23 concentrated on patients with persistent AF and showed no benefit from non‐inducibility. On the opposite side, Masuda et al 26 tested the role of substrate and its significance especially in patients with persistent AF and found more recurrence in the presence of substrate or inducibility (see the supplementary material Table 4).…”

Section: Discussionmentioning

confidence: 99%

Role of inducibility and its dynamic change in the outcome of catheter ablation of atrial fibrillation: a single center prospective study

Darma

Daneschnejad

Gaspar

et al. 2020

Background The role of atrial arrhythmia inducibility as an endpoint of catheter ablation of atrial fibrillation (AF) has been a controversial subject in many studies. Our goal is to evaluate the significance of inducibility, the impact of multiple sites or protocols of stimulation or the change in inducibility status in a prospective study including patients with AF undergoing first catheter ablation. Methods We studied 170 consecutive patients with AF (62.9% paroxysmal) undergoing catheter ablation. All patients underwent two separate stimulation protocols before and after the ablation from the coronary sinus ostium and the left atrial appendage: burst pacing at 300, 250, 200 milliseconds (or until refractoriness) for 10 seconds and ramp decrementing from 300 to 200 milliseconds in increments of 10 milliseconds every three beats for 10 seconds. Inducibility was defined as any sustained AF or organized atrial tachycardia (AT) lasting >30 seconds. Results We had AF/AT inducibility in 55 patients at baseline compared to 36 following ablation. After a mean of 41, 3 months follow‐up, 115 patients were free of AF. Inducibility before or after the ablation or change in inducibility status did not influence AF recurrence. There were no significant differences regarding paroxysmal or persistent patients with AF. Conclusions Non‐inducibility of atrial arrhythmia or change in inducibility status following pulmonary vein (PV) isolation and substrate modification are not associated with long‐term freedom from recurrent arrhythmia. Therefore, the use of induction of an endpoint in AF ablation is limited.