Abstract
Pulmonary vein (PV) automaticity is an established trigger for paroxysmal atrial fibrillation (PAF), making PV isolation (PVI) the cornerstone of catheter ablation. However, data on triggers for atrial fibrillation (AF) and catheter ablation strategy in very young patients aged <30 years are sparse. A total of 51 young patients (mean age 24.0 ± 4.2 years, 78.4% men) with drug-refractory PAF underwent electrophysiology (EP) study and ablation at 5 EP centers. None of the patients had structural heart disease or family history of AF. EP study induced supraventricular tachycardia (SVT) in 12 patients (n = 12, 23.5%): concealed accessory pathway mediated orthodromic atrioventricular reentrant tachycardia in 3 patients, typical atrioventricular nodal reentrant tachycardia in 6 patients, left superior PV tachycardia in 1 patient, left atrial appendage tachycardia in 1 patient, and typical atrial flutter in 1 patient. In patients with induced SVTs, SVT ablation without PVI was performed as an index procedure, except for the patient with atrial flutter who received cavotricuspid isthmus ablation in addition to PVI. Remaining patients underwent radiofrequency (n = 15, 29.4%) or second-generation cryoballoon-based PVI (n = 24, 47%). There were no major complications related to ablation procedures. Follow-up was based on outpatient visits including 24-hour Holter-electrocardiogram at 3, 6, and 12 months after ablation, or additional Holter-electrocardiogram was ordered in case of symptoms suggesting recurrence. Recurrence was defined as any atrial tachyarrhythmia (ATA) episode >30 seconds after a 3-month blanking period. A total of 2 patients with atrioventricular nodal reentrant tachycardia, 1 with left atrial appendage tachycardia, experienced AF recurrence within the first 3 months and received PVI. After the 3-month blanking period, during a median follow-up of 17.0 ± 10.1 months, 44 of 51 patients (86.2%) were free of ATA recurrence. In the PVI group, 33 of 39 patients (84.6%) experienced no ATA recurrence. In conclusion, SVT substrate is identified in around a quarter of young adult patients with history of AF, and targeted ablation without PVI may be sufficient in the majority of these patients. PVI is needed in the majority and is safe and effective in this population.
| Original language | English |
|---|---|
| Journal | American Journal of Cardiology |
| Volume | 166 |
| Pages (from-to) | 53-57 |
| Number of pages | 5 |
| ISSN | 0002-9149 |
| DOIs | |
| Publication status | Published - 01.03.2022 |
Funding
Dr. Eitel declares receiving presentation fees from Bayer, Biosense Webster, Impulse Dynamic, St. Jude Medical/Abbott, Pfizer, Liva Nova, Zoll, Boston Scientific, Novartis, Daiichi Sankyo, and AstraZeneca; and travel grants from St. Jude Medical, Biotronik, and Medtronic. Dr. Hegeer declares receiving travel grants and research grants from Boston Scientific, Biosense Webster, and Cardiofocus; and speaker's honoraria from Boston Scientific, Biosense Webster, and Cardiofocus. Dr. Tilz declares receiving travel grant from Biosense Webster, Abbot Medical, Medtronic, and Boston Medical; and speaker's bureau honoraria/procotor fees from Biosense Webster, Medtronic, Boston Scientific, Abbot Medical, Biotronik, Pfizer, Bristol-Myers Squibb, Bayer, and Sanofi Aventis (Bridgewater, New Jersey); publication fee from Boston Scientific; and consultant fees from Biosense Webster, Biotronik, and Boston Scientific. Dr. Gupta declares receiving speaker fee from Bayer, BMS/Pfizer, Boehringer Ingelheim (Ingelheim, Germany), Daiichi Sankyo, Medtronic, Biosense Webster, and Boston Scientific; proctor fees from Abbott; and research grants from Medtronic, Biosense Webster, and Boston Scientific. The remaining authors have no conflicts of interest to declare.
Research Areas and Centers
- Centers: Cardiological Center Luebeck (UHZL)
DFG Research Classification Scheme
- 2.22-12 Cardiology, Angiology
