Pulmonary vein isolation (PVI) with adjunctive lesions among patients with persistent atrial fibrillation (AFib) was associated with an increased risk of in-hospital complications, according to a recent study published in EP Europace.

Douglas Darden, MD, et al., included 50,937 patients (60% paroxysmal AFib, 40% persistent AFib) undergoing first-time AFib ablation between 2016 and 2020 captured by the ACC’s AFib Ablation Registry. Cases were separated into three groups for analysis: PVI only, PVI with cavotricuspid isthmus (CTI) ablation, and PVI with adjunctive lesions. Researchers then used multivariable logistic regression to determine adjusted odds of adverse events.

Among those with paroxysmal AFib, results showed patients undergoing additional CTI or adjunctive lesions were more likely to experience hospitalization greater than one day (CTI, adjusted odds ratio [OR], 1.12; 95% CI, 1.01- 1.25; p< 0.0001; adjunctive lesions, adjusted OR, 1.45; 95% CI, 1.30-1.62; p<0.0001); however, there was no significant difference in complications between the CTI or adjunctive lesions groups when compared to PVI only.

When looking at patients with persistent AFib, researchers found PVI with adjunctive lesions was associated with a higher risk of any complication (3.0 vs. 4.5%, odds ratio, 1.30; 95% CI, 1.07-1.58) and major complication (0.8 vs. 1.4%, OR, 1.56; 95% CI, 1.10-2.21). Specific complications such as stroke/transient ischemic attack, acute renal failure and heart failure, were statistically higher in the adjunctive lesions group in comparison to other groups. No differences in complication risk were seen between the CTI and PVI only groups.

The study authors note there was high heterogeneity in the adjunctive lesion type, as the group included superior vena cava isolation, coronary sinus, vein of Marshall, atypical atrial flutter lines, and other classifications. In addition, patients receiving adjunctive lesions were older with more comorbidities such as higher burden of coronary artery disease, heart failure, hypertension and diabetes.

“We observed several important in-hospital findings in patients undergoing PVI with or without adjunctive lesions…” state the authors. “While we observed a higher risk in those with persistent AFib undergoing adjunctive lesions, this analysis cannot establish a causal relationship between performing adjunctive ablations and complication risk.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: AFib Ablation Registry, Hospitalization, Stroke, Heart Failure, Atrial Flutter, Coronary Artery Disease, Vena Cava, Superior, Atrial Fibrillation, National Cardiovascular Data Registries

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