• Kwang-No Lee, Seung-Young Roh, Yong-Soo Baek, Hee-Soon Park, Jinhee Ahn, Dong-Hyeok Kim, Dae In Lee, Jaemin Shim, Jong-Il Choi, Sang-Weon Park, and Young-Hoon Kim.
• From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.).
• Circ Arrhythm Electrophysiol. 2018 Feb 1; 11 (2): e005019.

BackgroundPulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation.Methods And ResultsA total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups.ConclusionsElimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.© 2018 American Heart Association, Inc.

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