Silent pulmonary veins at redo atrial fibrillation ablation did not independently increase the risk of the primary composite outcome after multivariable adjustment (aHR 1.04).
Observational (n=467)
No
Does the finding of silent pulmonary veins at redo AF ablation predict adverse clinical outcomes compared to reconnected pulmonary veins?
Patients found to have silent pulmonary veins at redo AF ablation have higher rates of adverse outcomes and arrhythmia recurrence, though this is largely driven by baseline comorbidities and prior ablation history rather than the silent PVs themselves.
Estimación del efecto: aHR 1.04 (95% CI 0.47-2.29)
Tasa de eventos absoluta: 25% vs 13.8%
valor p: p=0.919
BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Despite promising success rates, redo ablation is sometimes required. At redo, PVs may be found to be isolated (silent) or reconnected. We studied patients with silent vs reconnected PVs at redo and analysed associations with adverse outcomes. METHODS: Patients undergoing redo AF ablations between 2013 and 2019 at our institution were included and stratified into silent PVs or reconnected PVs. The primary outcome was a composite of further redo ablation, non-AF ablation, atrioventricular nodal ablation, and death. Secondary outcomes included arrhythmia recurrence. RESULTS: A total of 467 patients were included with mean 4.6 ± 1.7 years follow-up, of whom 48 (10.3%) had silent PVs. The silent PV group had had more often undergone >1 prior ablation (45.8% vs 9.8%; p1 prior ablation (aHR 1.88 95% CI 1.30-2.72; p<0.001) were independently associated with arrhythmia recurrence. Whilst a finding of silent PVs was not itself significant after multivariable adjustment, this provides an easily assessable parameter at clinically indicated redo ablation which informs the clinician of the likelihood of a worse future prognosis. CONCLUSIONS: Patients with silent PVs at redo AF ablation have worse clinical outcomes.
Calvert et al. (Tue,) conducted a observational in Atrial fibrillation (n=467). Silent pulmonary veins vs. Reconnected pulmonary veins was evaluated on Composite of further redo ablation, non-AF ablation, atrioventricular nodal ablation, and death (aHR 1.04, 95% CI 0.47-2.29, p=0.919). Silent pulmonary veins at redo atrial fibrillation ablation did not independently increase the risk of the primary composite outcome after multivariable adjustment (aHR 1.04).