The Reliability of Atrial Fibrillation Vulnerability Test Using the Atrial Burst Decremental Pacing

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Background: Pulmonary veins isolation and atrial substrates using catheter ablation has been developed as a standard treatment for atrial fibrillation (AF). However, the standard end-point for these procedures still not well established. This study is aimed to investigate the characteristics among the positive and negative AF vulnerability patients with normal structural heart, in order to definite the endpoint of the atrial substrate modification. Methods: 49 supraventricular tachycardia patients with normal heart structure referred for electrophysiological study and catheter ablation were enrolled in this study. After eliminating the underling arrhythmias, the AF vulnerability test was performed by burse atrial decremental pacing from pacing cycle length 300 to 200 milliseconds. Results: AF was induced in 24 (48%) patients. Among these patients, there were 12 (24%) induced AF were found to be sustained (AF duration more than 10 milliseconds). However, only two of these patients could reproduce the positive result after 10 minutes of the first induced protocol. Comparing the patient baseline characteristics, P wave characteristics and cardiac echo parameters, there were no significant different between the positive and negative AF vulnerability groups. Conclusion: Atrial fibrillation could be induced in patient with normal structural heart. Protocol other than burse atrial decremental pacing should be investigated to evaluate the endpoint of the atrial substrate modification.

The Reliability of Atrial Fibrillation Vulnerability Test Using the Atrial Burst Decremental Pacing

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