Background: Acute arrhythmia termination during radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) was shown to be associated with a better procedure outcome. However, whether acute termination could be a reliable endpoint during ablation for induced atrial tachyarrhythmia is unknown.
Objective: The aim of this study was to evaluate the impact of acute arrhythmia termination in patients with persistent AF and having inducible arrhythmia after complete pulmonary vein isolation (PVI).
Methods: Among patients undergoing RFCA for persistent AF, 157 patients with continued atrial tachyarrhythmia after PVI and 93 patients who showed sinus rhythm after PVI and had inducible atrial tachyarrhythmia were enrolled. The impact of acute arrhythmia termination during further substrate modification on procedure outcome was compared between the two groups.
Results: Acute arrhythmia termination was achieved by further ablation in 51 (54.8%) in the induced arrhythmia group and 61 (38.9%) in the continued arrhythmia group. During a mean 35.8 months, acute arrhythmia termination did not significantly reduce long-term recurrence in the induced arrhythmia group [43.1% vs. 61.9%, hazard ratio (HR) 0.712, 95% confidence interval (CI) 0.400–1.266, p=0.247], while it was associated with a significantly lower arrhythmia recurrence in the continued arrhythmia group (34.4% vs. 55.2%, HR 0.590, 95% CI 0.355–0.979, p=0.038]. Among the overall population, acute arrhythmia termination was not an independent predictor for arrhythmia freedom in multivariate analysis.
Conclusion: In patients with inducible arrhythmia after PVI, further substrate modification targeting termination of induced rhythm may not be an effective ablation strategy during RFCA for persistent AF.