Patients with persistent pulmonary vein isolation at repeat AF ablation had a higher risk of recurrent atrial tachyarrhythmias than those with PV reconnection (HR 3.6; 95% CI 1.6-8.3; P=0.002).
Cohort (n=152)
Does repeat ablation targeting non-PV triggers improve sinus rhythm maintenance in recurrent AF patients with persistently isolated pulmonary veins compared to those with pulmonary vein reconnection?
In patients undergoing repeat AF ablation, those with persistently isolated pulmonary veins have lower long-term sinus rhythm maintenance compared to those with reconnected veins, despite targeting non-PV triggers.
Effect estimate: HR 3.6 (95% CI 1.6-8.3)
Absolute Event Rate: 56% vs 76.3%
p-value: p=0.036
BACKGROUND: The cornerstone of atrial fibrillation (AF) ablation is isolation of the pulmonary veins (PVs). Patients with recurrent AF undergoing repeat ablation usually have PV reconnection (PVr). The ablation strategy and outcome of patients undergoing repeat ablation who have persistent isolation of all PVs (PVi) at the time of repeat ablation is unknown. METHODS AND RESULTS: We studied consecutive patients with recurrent AF undergoing repeat ablation and compared patients with PVi to those with PVr. One hundred fifty-two patients underwent repeat ablation, and of these, 25 patients (16.4%) had PVi. Patients with PVi underwent ablation targeting any isoproterenol induced AF triggers, atrial substrate, or inducible atrial tachycardias or flutters. Patients with PVi compared to PVr were more likely to have a history of persistent AF (64% vs. 26%; P < 0.0001), obesity (BMI 30.4 vs. 28.2; P = 0.05), and prior use of contact force sensing catheters (28% vs. 0.8%, P < 0.0001). After a mean follow-up of 19 ± 15 months, 56% of PVi patients remained in sinus rhythm compared to 76.3% of PVr patients (P = 0.036). In a multivariable model, PVi patients and those with cardiomyopathy had a higher risk of recurrent atrial tachyarrhythmias (HR = 3.6 95%, CI 1.6-8.3, P = 0.002 and HR = 6.2, 95% CI 2.3-16.3, P < 0.0001, respectively). CONCLUSION: In patients who have all PVs isolated at the time of the redo AF ablation, a strategy of targeting non-PV AF triggers and inducible flutters can still lead to AF freedom in more than half of patients. Patients with PVr, however, have a better long-term outcome.
Szílágyi et al. (Fri,) conducted a cohort in Recurrent atrial fibrillation (n=152). Persistent isolation of all pulmonary veins (PVi) vs. Pulmonary vein reconnection (PVr) was evaluated on Maintenance of sinus rhythm (HR 3.6, 95% CI 1.6-8.3, p=0.036). Patients with persistent pulmonary vein isolation at repeat AF ablation had a higher risk of recurrent atrial tachyarrhythmias than those with PV reconnection (HR 3.6; 95% CI 1.6-8.3; P=0.002).
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