Various repeat ablation strategies in patients with durably isolated pulmonary veins showed no significant difference in atrial arrhythmia recurrence rates over a median 2-year follow-up, with 52.8% experiencing recurrence.
Observational (n=274)
Yes
Do specific re-ablation strategies improve atrial arrhythmia-free survival compared to no additional ablation or other strategies in patients with recurrent AF and durably isolated pulmonary veins?
In patients undergoing repeat ablation for recurrent AF who have durably isolated pulmonary veins, performing additional empirical ablation strategies does not significantly reduce the risk of future atrial arrhythmias compared to no additional ablation.
Effect estimate: No significant difference in arrhythmia recurrence between ablation strategies (p > 0.05)
p-value: p=>0.05
Abstract Background and aims In 15–40% of patients undergoing repeat ablation for AF recurrence, all pulmonary veins (PVs) are durably isolated. Currently, there is limited evidence on the appropriate treatment strategy for these patients. We aimed to characterize and compare the effectiveness of different re-ablation strategies. Methods All patients referred for repeat AF ablation with all PVs durably isolated at 8 hospitals in the Netherlands were included Netherlands-Heart-Registration (NHR); 2016–2019. NHR data were were used to determine the presence of PV-reconnection, the ablation strategy used, and the outcome of ablation (atrial arrhythmia recurrence > 30 sec.). The effectiveness of ablation strategies was assessed with multivariable Cox models. Results Of 2311 repeat AF ablations performed, 274 (11.9%) patients had all PVs durably isolated. Median age was 66 (IQR:58–70) years, 44.2% women, 45.6% had persistent/long-standing-persistent AF. In 33 (12.0%) patients, no ablation was performed. A single ablation strategy was performed most often (41.2%). Posterior wall ablation (58.4%) was performed most often, followed by PV-antralization (26.3%). Over 2.0 (1.0–3.3) years, 147 (59.8%) patients had an atrial arrhythmia recurrence, and 30 (12.7%) patients had another repeat AF ablation within 1 year. After multivariable adjustment, no difference in atrial-arrhythmia recurrences was detected between individual ablation strategies, number of strategies performed, and type of atrial-arrhythmia ( p > 0.05 for all). Left-atrial-volume-index was associated with a higher recurrence-risk aHR 1.03(95%CI 1.01–1.05). Conclusion In patients with durably isolated PVs, a high proportion experienced recurrence of atrial arrhythmias, with no difference in recurrence rates between different re-ablation strategies.
Magni et al. (Wed,) conducted a observational in Atrial fibrillation recurrence with durably isolated pulmonary veins (n=274). Various repeat ablation strategies including no ablation, posterior wall ablation, PV antralization, linear ablation, trigger ablation, low-voltage area ablation, CFAE ablation vs. No additional ablation or other ablation strategies was evaluated on Atrial arrhythmia recurrence (> 30 seconds) after a 90-day blanking period (No significant difference in arrhythmia recurrence between ablation strategies (p > 0.05), p=>0.05). Various repeat ablation strategies in patients with durably isolated pulmonary veins showed no significant difference in atrial arrhythmia recurrence rates over a median 2-year follow-up, with 52.8% experiencing recurrence.