Abstract
BACKGROUND: Two methods for testing inducibility of atrial fibrillation (AF)-atrial pacing and isoproterenol infusion-have been proposed to determine the endpoint of catheter ablation. However, the utility of the combination for testing electrophysiological inducibility (EPI) and pharmacological inducibility (PHI) is unclear. METHODS: After pulmonary vein isolation (PVI), inducibility of atrial tachyarrhythmia was assessed with the dual methods in 291 consecutive patients with AF (65% paroxysmal) undergoing initial catheter ablation. RESULTS: The incidence of EPI was significantly higher in patients with persistent AF than paroxysmal AF (32.0% vs 11.7%, respectively, P < .001). The incidence of PHI was not significantly different between the two groups (25.2% vs 26.1%, respectively, P = .87). There was no significant difference in AF recurrence according to inducibility in paroxysmal AF. In persistent AF, however, patients achieving neither EPI nor PHI under PVI-only strategy had significantly lower rates of AF recurrence than those achieving either EPI or PHI and consequently requiring additional ablation for inducible atrial tachyarrhythmia (68.5% vs 49.0%, respectively; log-rank test, P = .022). In persistent AF, multivariate Cox regression analysis showed that achieving neither EPI nor PHI was a negative independent predictor of AF recurrence (HR 0.492, 95% CI 0.254-0.916, P = .026). CONCLUSIONS: Achieving neither EPI nor PHI following PVI was associated with favorable outcome in patients with persistent AF. The combination of tests may discriminate patients responsive to the PVI-only strategy. Further selective approaches are necessary to improve outcome for inducible atrial tachyarrhythmia in patients with persistent AF.