Purpose: This study aimed to assess pulmonary vein isolation (PVI) efficacy on atrial fibrillation (AF) recurrence and to determine a predictive dispersion of atrial refractoriness (dERP) value for performing PVI in paroxysmal supraventricular tachycardia (PSVT) patients.
Methods: Of 67 PSVT patients with past AF episodes who underwent accessory pathway (AP) or slow pathway of atrioventricular node ablation, 63 (4 lost to follow-up or death) were assigned into two groups (A and B; 29 and 34 patients, respectively) based on whether they underwent or not subsequent PVI, and all were followed-up up to 3 years. Atrial effective refractory period (AERP) and dERP were measured during the ablation procedure.
Results: In receiver operating characteristic (ROC) curve analysis, dERP = 74.5 ms effectively predicted AF recurrence in PSVT patients (p = 0.003). Difference in AF recurrence rate between groups did not reach statistical significance (17.2%, 5/29 vs. 29.4%, 10/34, p = 0.203). AF recurrence rate was lower in patients with dERP >74.5 ms who underwent AP or slow-pathway ablation with vs. without PVI (18.2%, 2/11 vs. 77.8%, 7/9, p = 0.012).
Conclusions: PVI addition after successful AP or slow pathway of atrioventricular node ablation significantly reduced AF recurrence in PSVT patients with high atrial vulnerability (dERP >74.5 ms).