title: Clinical Significance of Additional Ablation of Atrial Premature Beats after Catheter Ablation for Atrial Fibrillation.
abstract: OBJECTIVE
  The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation.
  
  
  METHODS
  We enrolled 200 patients with AF (76.5% males; 57.4±11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (≥6/min) under isoproterenol infusion (5 μg/min), monitored for 10 min after internal cardioversion, and we ablated mappable IRAPBs. Post-procedural IRAPB provocations were conducted in 100 patients. We compared the patients who showed IRAPB with those who did not. We also compared the IRAPB provocation group with 100 age-, sex-, and AF-type-matched patients who completed ablation without provocation (No-Test group).
  
  
  RESULTS
  1) Among the post-procedural IRAPB provocation group, 33% showed IRAPB and required additional ablation with a longer procedure time (p=0.001) than those without IRAPB, without increasing the complication rate. 2) During 18.0±6.6 months of follow-up, the patients who showed IRAPB had a worse clinical recurrence rate than those who did not (27.3% vs. 9.0%; p=0.016), in spite of additional IRAPB ablation. 3) However, the clinical recurrence rate was significantly lower in the IRAPB provocation group (15.0%) than in the No-Test group (28.0%; p=0.025) without lengthening of the procedure time or raising complication rate.
  
  
  CONCLUSIONS
  The presence of post-procedural IRAPB was associated with a higher recurrence rate after AF ablation. However, IRAPB provocation and additional ablation might facilitate a better clinical outcome. A further prospective randomized study is warranted.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: In Soo
authors.initials: IS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Pil Sung
authors.initials: PS
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Junbeum
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Jin Kyu
authors.initials: JK
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Jae Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Moon Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea. hnpak@yuhs.ac.
authors.forename: Hui Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology*; D005117:Cardiac Complexes, Premature; D017115:Catheter Ablation / Q000379:methods*; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
keywords: Atrial fibrillation; atrial premature beats; catheter ablation; recurrence