Impact of the first-pass pulmonary vein isolation on ablation outcomes in persistent atrial fibrillation

Chenxu Luo; Bing Leng; Xinzhi Yu; Xianfeng Du; Huimin Chu; Shenyuan Zhou; Caijie Shen; Mingjun Feng; Yongxing Jiang; He Jin; Guohua Fu; Lipu Yu; Binhao Wang; Yibo Yu; Weidong Zhuo; Fang Gao; Yin Xu; Yijun Sun; Jiating Dai; Luigi Di Biase

doi:10.3389/fcvm.2025.1588716

Impact of the first-pass pulmonary vein isolation on ablation outcomes in persistent atrial fibrillation

Front Cardiovasc Med. 2025 Jun 5:12:1588716. doi: 10.3389/fcvm.2025.1588716. eCollection 2025.

Authors

Chenxu Luo^#^{1

2

3}, Bing Leng^#^{1

4}, Xinzhi Yu^#^{1

2

3}, Xianfeng Du^{1

2}, Huimin Chu^{1

2}, Shenyuan Zhou^{1

2

3}, Caijie Shen^{1

2}, Mingjun Feng^{1

2}, Yongxing Jiang^{1

2}, He Jin^{1

2}, Guohua Fu^{1

2}, Lipu Yu^{1

2}, Binhao Wang^{1

2}, Yibo Yu^{1

2}, Weidong Zhuo^{1

2}, Fang Gao^{1

2}, Yin Xu^{1

2}, Yijun Sun^{1

2

3}, Jiating Dai^{1

2

3}, Luigi Di Biase⁵

Affiliations

¹ Arrhythmia Center, The First Affiliated Hospital of Ningbo University, Ningbo First Hospital, Ningbo, China.
² Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, The First Affiliated Hospital of Ningbo University, Ningbo, China.
³ Health Science Center, Ningbo University, Ningbo, China.
⁴ Department of Cardiology, Ningbo Taikang Hospital, Ningbo, China.
⁵ Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States.

^# Contributed equally.

Abstract

Background: 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.

Methods: 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.

Result: 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).

Conclusion: Achieving FPI for PVI remained a significant association with improved ablation outcomes in PeAF patients, wherein IFPI served as an important determinant.

Keywords: ablation outcome; first-pass isolation; persistent atrial fibrillation; pulmonary vein isolation; radiofrequency ablation.