Yuma Gibo

and 14 more

Background Although pulmonary vein isolation (PVI) is a cornerstone treatment for atrial fibrillation (AF), recurrence remains a significant challenge. Post-PVI atrial burst pacing is used to unmask latent arrhythmogenic substrates and guide further ablation; however, the efficacy of the induction test itself in reducing recurrence remains unclear. Methods This single-center retrospective study evaluated 289 patients who underwent initial catheter ablation for AF between June 2021 and June 2023. Patients were divided into two groups: induction test (n=248) and non-induction test (n=41). In the induction test group, atrial burst pacing was performed after PVI, with additional ablation carried out at the operator’s discretion if AF or atrial tachycardia (AT) was induced. The primary endpoint was AF/AT recurrence beyond a three-month blanking period. Secondary endpoints included procedure duration and complication rates. Results The one-year recurrence-free survival was 76.0% in the induction test group versus 79.8% in the non-induction test group (p=0.412), indicating no significant difference. Among patients in the induction test group, 67.2% exhibited no inducible AF/AT, 25.7% had inducible AF/AT treated with cardioversion, and 7.1% underwent additional ablation. Fractionated atrial electrogram ablation was performed significantly more frequently in the induction test group (12.86% vs. 2.08%, p=0.030). The procedure time was significantly shorter in the non-induction test group (128.1±39.5 vs. 145.2±39.6 minutes, p=0.007). Complication rates were comparable between the two groups (1.24% vs. 2.08%, p=0.650). Conclusions Induction testing with atrial burst pacing following PVI did not reduce AF recurrence but significantly increased procedure duration. These findings suggest that omitting inducibility testing may enhance procedural efficiency without adversely affecting clinical outcomes.