A higher number of reconnected pulmonary veins was independently associated with a lower recurrence of atrial fibrillation after a second ablation procedure (HR 0.56; 95% CI 0.34-0.95; P=0.032).
Cohort (n=143)
Does the presence of pulmonary vein reconnection predict clinical recurrence of atrial fibrillation after a second catheter ablation?
In patients undergoing a second AF ablation, the presence of pulmonary vein reconnection is paradoxically associated with better clinical outcomes (lower AF recurrence) compared to those with maintained PV isolation.
Estimación del efecto: HR 0.56 (95% CI 0.34-0.95)
valor p: p=0.032
AIMS: Although electrically reconnected pulmonary veins (PV) are the main mechanism of atrial fibrillation (AF) recurrence, PV isolation (PVI) is well-preserved in certain patients who undergo a repeat procedure. We explored the association between PV reconnection and clinical outcomes after a second ablation. METHODS AND RESULTS: This observational cohort study included 143 patients (79.0% male, 56.1 ± 10.0 years old, 65.0% paroxysmal AF) who underwent a second procedure. Pulmonary vein isolation was well-maintained in 52 patients (PVP- group, 36.4%), although the remaining 91 patients showed PV reconnection (PVP+ group). After confirming PVI, we mapped non-PV triggers and conducted trigger ablation or additional linear ablation at redo-procedures. The proportion of females was higher (P = 0.030), and redo-ablation timing after the de novo procedure was later (P = 0.039) in the PVP- group than in the PVP+ group. Additional linear ablations were more likely to be performed in the PVP- group (90.4 vs. 61.5%, P < 0.001). During the 18.4 ± 10.2 month follow-up after the redo-ablation, the PVP+ group showed a lower clinical recurrence rate than the PVP- group (log-rank P = 0.011). The number of reconnected PVs was independently associated with a lower recurrence of AF after the redo-ablation in the total study population (HR 0.56, 95% CI 0.34-0.95, P = 0.032), particularly for patients with paroxysmal AF (HR 0.41, 95% CI 0.19-0.87, P = 0.021). CONCLUSION: Among patients who underwent redo-AF ablation, those with more PV reconnections showed better clinical outcomes than those with fewer PV reconnections. The mechanism of AF recurrence might be different in patients with lower numbers of PV reconnections during redo-procedures.
Kim et al. (Thu,) conducted a cohort in Atrial fibrillation (n=143). Pulmonary vein reconnection (PVP+) vs. Maintained pulmonary vein isolation (PVP-) was evaluated on Clinical recurrence of atrial fibrillation (HR 0.56, 95% CI 0.34-0.95, p=0.032). A higher number of reconnected pulmonary veins was independently associated with a lower recurrence of atrial fibrillation after a second ablation procedure (HR 0.56; 95% CI 0.34-0.95; P=0.032).