Predictive value of noninducibility after catheter ablation for paroxysmal and persistent atrial fibrillation

It is unclear whether pacing maneuver at the end of catheter ablation for atrial fibrillation (AF) predicts recurrence of atrial tachyarrhythmia postintervention.

To investigate whether the predictive value of incremental pacing maneuver after catheter ablation for AF depends on the pacing cycle length and type of AF.

This study included 298 consecutive patients who underwent initial catheter ablation for nonvalvular AF (61% paroxysmal AF [PAF], 39% persistent AF [PeAF]). Rapid atrial pacing was performed at the end of the procedure. We analyzed minimum coupling interval (CI) of pacing, arrhythmia-inducibility, and atrial tachyarrhythmia recurrence in patients with PAF and PeAF.

Patients were divided into the following three groups according to their response to pacing maneuver: AF-inducible (inducible group; n = 86), noninducible at CI ≥200 ms (non-CI ≥200 group; n = 100), and noninducible at CI <200 ms (non-CI <200 group; n = 112). Kaplan-Meier analysis showed that response to pacing maneuver was significantly associated with recurrence of atrial tachyarrhythmias (P = .028). Cox-regression analysis showed that non-CI <200 was an independent predictor when the inducible group was used as a reference (hazard ratio 0.60, 95% confidence interval 0.40-0.96, P = .031). However, when PAF and PeAF were analyzed separately, non-CI <200 was an independent predictor only in PeAF.

Noninducibility with shorter CI predicted atrial tachyarrhythmia recurrence only for PeAF. Pacing CI and type of AF could influence the predictive value of atrial tachyarrhythmia recurrence.