Background
The atrial defibrillation threshold (ADFT) for internal cardioversion is theoretically
related to the critical mass for sustaining atrial fibrillation (AF).
Objective
This study aimed to investigate the association of ADFT for internal cardioversion
with the outcome of catheter ablation for non-paroxysmal AF (non-PAF).
Methods
We included 368 consecutive patients who underwent first-time catheter ablation for
non-PAF. Based on the degree of ADFT recorded by the internal cardioversion before
pulmonary vein isolation, we divided the patients into low ADFT (<20 J) and high ADFT
(≥20 J) groups and analysed the association between ADFT and atrial tachyarrhythmia
recurrence.
Results
There were 234 and 134 patients in the low and high ADFT groups, respectively. Of
these, 39 patients (16.7%) and 41 (30.6%) patients, respectively, had atrial tachyarrhythmia
recurrence during the 2.6±1.0 year follow-up. The high ADFT group showed a significantly
higher atrial tachyarrhythmia recurrence than the low ADFT group (p=0.002). This finding
was also noted in patients with long-standing persistent AF (p=0.032) but not in patients
with persistent AF (p=0.159). The significant predictors of arrhythmia recurrence
on multivariate analysis were high ADFT (p=0.004) and long-standing persistent AF
(p=0.011). In multivariate analysis within the long-standing persistent AF group,
only ADFT remained a significant risk factor for AF recurrence (p=0.035).
Conclusions
The high ADFT of internal cardioversion was found to be a risk factor for post-catheter
ablation recurrence in patients with long-standing persistent AF but not in those
with persistent AF.
Keywords
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Article info
Publication history
Published online: June 03, 2022
Accepted:
April 18,
2022
Received in revised form:
March 9,
2022
Received:
December 16,
2021
Identification
Copyright
© 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
