title: Is inducibility of atrial fibrillation after radio frequency ablation really a relevant prognostic factor?
abstract: OBJECTIVE
  The study was intended to assess the prognostic value of inducibility of atrial fibrillation (AF) after radio frequency ablation.
  
  
  RESULTS
  Two hundred and thirty four patients with drug-resistant paroxysmal (n=165) or persistent AF (n=69) underwent either Lasso-guided segmental pulmonary vein isolation (n=83) or CARTO-guided left atrial circumferential ablation (n=151). After ablation, two attempts to induce AF (>1 min) by decremental coronary sinus stimulation were performed. Patients were followed for at least 6 months (median: 12.7 months). At 6 months of follow-up, 67% of patients with paroxysmal and 48% of patients with persistent AF were AF-free. Inducibility of AF was a significant predictor of AF recurrence in univariate [hazard ratio (HR)=2.32, P<0.001] and multivariable (HR=2.19, P<0.001) Cox regression analyses. The prognostic value of inducibility was present in both patients with paroxysmal (HR=2.38, P=0.001) and persistent AF (HR=1.91, P=0.034) and did not significantly differ between both ablation techniques. The sensitivity, specificity, positive, and negative predictive values of the AF induction test to predict the 6-month ablation outcome were 46.7, 75, 53.8, and 69.2%, respectively.
  
  
  CONCLUSIONS
  Inducibility of AF after ablation is a significant predictor of recurrent AF. However, owing to the low diagnostic accuracy of the AF induction test, non-inducibility does not qualify as reliable procedural endpoint.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. bernhard.richter@meduniwien.ac.at
authors.forename: Bernhard
authors.initials: B
authors.lastname: Richter
authors.forename: Marianne
authors.initials: M
authors.lastname: Gwechenberger
authors.forename: Peter
authors.initials: P
authors.lastname: Filzmoser
authors.forename: Manfred
authors.initials: M
authors.lastname: Marx
authors.forename: Peter
authors.initials: P
authors.lastname: Lercher
authors.forename: Heinz D
authors.initials: HD
authors.lastname: Gössinger
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D016896:Treatment Outcome