The tachyarrhythmia induction test with atrial burst pacing is a simple and feasible technique to evaluate therapeutic efficacy and/or endpoint of catheter ablation. However, its role in atrial fibrillation (AF) ablation is controversial.1 Induced AF in response to atrial burst pacing may reflect residual arrhythmogenic substrates in the atria that could maintain AF. At the same time, a response to atrial burst pacing may be a nonspecific phenomenon with relatively poor reproducibility. In the current issue, Tachibana et al reported that AF induction test with atrial burst pacing has no predictive value for long‐term recurrence in their whole‐studied population, but has a significant predictive value when tested in shorter cycle length of pacing in persistent AFpatients. 2 Previous reports have shown that predictive value of AF induction test with atrial burst pacing has, if any, an only limited value, as Tachibana et al well summarized in their discussion section and a table.2 The positive predictive value (PPV) of atrial burst pacing for clinical recurrence is very low. This means that an induction positive is “false positive” in most of the cases. On the other hand, negative predictive value (NPV) of atrial burst pacing is relatively high in the series of study.
VARIETY OF INDUCTION PROTOCOL AND DEFINITION OF POSITIVE INDUCTION
Differences in stimulation protocol and definition of inducibility among the present and previous studies should be mentioned. Pacing cycle length, number or duration of burst pacing may lead to different results. Furthermore, definition of inducibility (ie, duration of induced AF) varies among studies. 1, 2 Characteristics of studied population may also influence study results and interpretations. These heterogeneities of investigation might have affected the each study result. Nevertheless, general findings may be quite conserved among the present and previous studies.
CLINICAL USAGE OF INDUCTION TESTING WITH ATRIAL BURST PACING
Although the response to atrial burst pacing has weak, but significant prognostic value, no prospective study has proven a value of additional atrial substrate ablation in addition to pulmonary vein isolation according to the result of AF induction testing. Thus, induction testing with atrial burst pacing is no more than a considerable reference, but does not have a crucial role to determine therapeutic strategies in the clinical practice of AF ablation. Rather, we utilize atrial burst pacing as a tool to induce clinical atrial tachycardias in some cases, or to induce AF that would be terminated to seek an AF trigger.
CONFLICT OF INTEREST
The authors declare no conflict of interests for this article.