Defibrillation threshold of internal cardioversion prior to ablation
predicts atrial fibrillation recurrence
Abstract
Background: Many studies have reported the predictors of atrial
fibrillation (AF) recurrence after persistent AF (peAF) ablation.
However, the correlation between the atrial defibrillation threshold
(DFT) for internal cardioversion (IC) and AF recurrence rate is
little-studied. We investigated the relationship between DFT prior to
catheter ablation for peAF and the AF recurrence. Method and Results:
From June 2016 to May 2019, we enrolled 82 consecutive patients (mean
age 65.0 ± 12.4 years), including 45 patients with peAF and 37 with
long-standing peAF, at Hamamatsu medical center. In order to assess the
DFT, we performed IC with gradually increasing energy prior to
radiofrequency application. Forty-nine and 33 patients showed DFT values
less than or equal to 10 J (group A) and greater than 10 J or
unsuccessful defibrillation (group B), respectively. During the mean
follow-up duration of 20.5 ± 13.1 months, patients in group B showed
significantly higher AF recurrence rates than those in group A after the
ablation procedure (P = 0.017). Multivariate analysis revealed that the
DFT was the only predictive factor for AF recurrence (OR=1.07; 95% CI:
1.00-1.13, P = 0.047). Conclusions: The DFT for IC was one of the
strongest prognostic factors in the peAF ablation procedure.