Concomitant Pulmonary Vein Isolation for induced Atrial fibrillation to reduce future risk of atrial fibrillation following Ablation for Isolated Atrial Flutter

Background: A significant proportion of patients with isolated atrial flutter (AFL) will develop atrial fibrillation (AF) following cavotricuspid isthmus (CTI) ablation.

Objective: To determine whether concomitant pulmonary vein isolation (PVI) could reduce the incidence of new-onset atrial fibrillation (NOAF) in the setting of inducible AF following CTI ablation.

Methods: A total of 275 consecutive patients with isolated AFL who successfully underwent CTI ablation were included. Patients were stratified into the induced AF group (55 patients) and the non-induced AF group (220 patients) based on the inducibility of AF. Subsequently, the induced AF group was randomly divided into PVI group (28 patients) and non-PVI (27 patients) group.

Results: During 27.0±6.0 months of follow-up, the PVI group [(7.1% vs. 51.9%, p<0.001), HR 0.103, 95%CI. for HR (0.038, 0.278), p<0.001] and non-induced AF group [(13.2% vs. 51.9%, p<0.001), HR 0.207, 95%CI. for HR (0.073, 0.586), p<0.001] exhibited substantially lower incidence and risk of NOAF compared to the non-PVI group. Kaplan-Meier analysis showed that history of hypertension, cardiovascular disease, heart failure and larger BMI, larger LAd, lower LVEF were identified predictors of NOAF.

Conclusion: Inducibility of AF during CTI ablation is positively associated with an increased risk of NOAF, while concomitant PVI for induced AF can significantly reduce the incidence of NOAF.