ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1588716
Impact of the first-pass pulmonary vein isolation on ablation outcomes in persistent atrial fibrillation
Provisionally accepted
Chenxu Luo1,2,3
Bing Leng1,4Xinzhi Yu1,2,3
Xianfeng Du1,2*
Huimin Chu1,2*
Shenyuan Zhou1,2,3
Caijie Shen1,2Mingjun Feng1,2Yongxing Jiang1,2
Guohua Fu1,2Lipu Yu1,2
Binhao Wang1,2
YU YIBO1,2Weidong Zhuo1,2Yin Xu1,2
Yijun Sun1,2,3Jiating Dai1,2,3
Luigi Di Biase5- 1Arrhythmia Center, The First Affiliated Hospital of Ningbo University, Ningbo, China
- 2Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China
- 3Health Science Center, Ningbo University, Ningbo, China
- 4Department of Cardiology, Ningbo Taikang Hospital, Ningbo, China
- 5Montefiore Medical Center, Albert Einstein College of Medicine, New York, United States
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The achievement of first-pass isolation (FPI) during pulmonary vein isolation (PVI) generally serves as a reliable marker of lesion quality in initial radiofrequency encirclement and predicts favorable procedural outcomes. This study sought to evaluate the impact of the FPI on the long-term clinical outcomes in persistent atrial fibrillation (PeAF) patients undergoing radiofrequency ablation.We conducted a retrospective analysis of 346 patients with PeAF who were divided into three groups: patients with FPI in bilateral PVs (BOTH group, n=197), those with FPI in either ipsilateral PVs (EITHER group, n=92), and those without FPI in bilateral PVs (NEITHER group, n=57). Achieving FPI in at least one of the two ipsilateral PVs (at least ipsilateral FPI, IFPI) was utilized as a metric for evaluation.The primary endpoint was freedom from atrial tachyarrhythmias (ATAs) lasting longer than 30s beyond the blanking period. Baseline characteristics, procedural results and long-term clinical outcomes were compared among the groups.The FPI was effectively achieved in 251 left PVs (72.5%) and 235 right PVs (67.9%). After a median follow-up of 658(402, 970) days, the NEITHER group exhibited less freedom from ATAs recurrence than the BOTH group (57.9% vs 75.1%, P<0.001) or the EITHER group (57.9% vs 70.7%, P=0.036). IFPI was an independent predictor of freedom from ATAs recurrence in PeAF patients undergoing their initial ablation (HR, 0.46; 95% CI, 0.29-0.74; P =0.001).Achieving FPI for PVI remained a significant association with improved ablation outcomes in PeAF patients, wherein IFPI served as an important determinant.
Keywords: AT, atrial tachycardia, ATAs, atrial tachyarrhythmias, FPI, first-pass isolation, PVI, pulmonary vein isolation, PAF, paroxysmal atrial fibrillation, PeAF, persistent atrial fibrillation, LSPAF, long-standing persistent atrial fibrillation
Received: 06 Mar 2025; Accepted: 08 May 2025.
Copyright: © 2025 Luo, Leng, Yu, Du, Chu, Zhou, Shen, Feng, Jiang, Fu, Yu, Wang, YIBO, Zhuo, Xu, Sun, Dai and Di Biase. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xianfeng Du, Arrhythmia Center, The First Affiliated Hospital of Ningbo University, Ningbo, China
Huimin Chu, Arrhythmia Center, The First Affiliated Hospital of Ningbo University, Ningbo, China
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