What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=85). Intervention: Radiofrequency catheter ablation for pulmonary vein isolation. Primary outcome: Recovery of left atrium to pulmonary vein (LA-PV) conduction in patients with recurrent AF.

What does this research mean for the field?

In patients with recurrent atrial fibrillation after pulmonary vein isolation, the major cause of recurrence is the recovery of conduction from the previously ablated segment, which was observed in 83% of patients and 71% of isolated veins. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 27, 2004Open Access

Conduction Recovery After Pulmonary Vein Isolation for Atrial Fibrillation

Key Result

In patients with recurrent atrial fibrillation after pulmonary vein isolation, recovery of conduction from the previously ablated segment was observed in 83% of patients and 71% of isolated veins.

Study Design

Type

Observational (n=85)

Multicenter

Structured PICO

Does recovery of pulmonary vein conduction cause recurrence of atrial fibrillation after pulmonary vein isolation in patients with drug-refractory AF?

Population

85 patients with symptomatic, drug-refractory atrial fibrillation (81 paroxysmal, 4 persistent) undergoing pulmonary vein isolation. Mean age 57±11 years, 64 men. Key inclusion criteria: age ≤75 years, left atrium maximal transverse diameter ≤50mm. 30 of 48 patients who had recurrence after the first session underwent a second session and were evaluated.

Intervention

Second session of radiofrequency catheter ablation (RF-CA) targeting reconnected pulmonary veins and new foci

Outcome

Recovery of conduction between the left atrium and pulmonary vein (LA-PV conduction recurrence) assessed during the second ablation sessionsurrogate

The major cause of atrial fibrillation recurrence after pulmonary vein isolation is the recovery of conduction from previously ablated segments, suggesting that additional targeted ablation sessions can improve procedural success.

Limitations

The ring catheter at the PV ostium was unstable in some cases, so the PV potentials at the PV may not have been adequately reproduced.
Because this was a retrospective study, further detailed prospective examinations may be necessary.

Abstract

BACKGROUND: Although pulmonary vein (PV) isolation is useful for curing atrial fibrillation (AF), its recurrence rate is still high, so the aim of the present study was to investigate the cause of recurrence after PV isolation. METHODS AND RESULTS: Eighty-five patients with paroxysmal AF underwent PV isolation and AF recurred in 48 patients after the first session. Thirty of these 48 patients who underwent a second session were evaluated. In 49 (71%) of 69 PVs ablated in 25 patients (83%), recovery of conduction was observed between the left atrium and PV. In 45 (92%) of 49 PVs, conduction recurrences were seen from the same segment or part of a segment that was ablated in the first session. However, in the other 4 PVs (8%), conduction recurrences occurred in a different segment that had not been ablated before. In the second session, the mean number of segments ablated in the PV ostium was significantly less than in the first session (2.3+/-5.0 vs 1.4+/-6.0, p<0.01). After the second session, 16 patients (53%) did not show recurrence of AF. CONCLUSION: The major cause of recurrence of PV isolation was recovery of PV conduction from the same segment that had been ablated in the PV ostium. Therefore, an additional session may be necessary to increase the success rate.

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