Late conduction recurrence across radiofrequency lesions disconnecting pulmonary veins occurs in approximately 80% of cases 4 months after ablation, with similar rates 5 months after reablation.
Cohort (n=43)
Late conduction recurrence across pulmonary vein isolation lesions is highly prevalent (~80%) at 4-5 months post-ablation, likely contributing significantly to clinical atrial fibrillation recurrence.
BACKGROUND: In patients with atrial fibrillation (AF) undergoing radiofrequency (RF) electrical disconnection of multiple pulmonary veins (PVs), the incidence of late conduction recurrences has not been systematically determined. METHODS AND RESULTS: Using a prospectively designed, multistep approach, we aimed at assessing the correlation between acute achievement and chronic maintenance of electrical conduction block across RF lesions disconnecting the distal tract of the PV in 43 patients (52.3+/-8.2 years) with AF. Forty-one left superior (LS), 42 right superior (RS), 25 left inferior (LI), and 9 right inferior (RI) PVs were targeted during 108 EP procedures (2.6+/-0.5 per patient). Seventeen patients underwent 2 procedures, 23 patients underwent 3 procedures, and 3 patients underwent 4 procedures. During the first attempt, electrical disconnection was achieved in 112 PVs (95.7%). During a next procedure (time interval, 4.6+/-1.9 months), conduction recurrence was observed in 32 of 39 LSPVs (82.1%), 29 of 40 RSPVs (72.5%), 20 of 24 LIPVs (83.3%), and 7 of 9 RIPV (77.8%). After reablation at gap sites, a later procedure (time interval, 5.1+/-2.4 months) revealed a second recurrence in 13 of 22 LSPVs (59.1%) and 14 of 19 RSPVs (73.7%). CONCLUSIONS: Conduction recurrence across disconnecting RF lesions can be observed in approximately 80% of cases 4 months after ablation. After reablation, similar recurrence rates are observed 5 months later. This high rate of late conduction recurrence may contribute significantly to AF recurrence in patients undergoing catheter ablation aiming at disconnection of multiple PVs.
Cappato et al. (2003) conducted a cohort in Atrial fibrillation (n=43). Radiofrequency electrical disconnection of pulmonary veins was evaluated on Late conduction recurrence across radiofrequency lesions. Late conduction recurrence across radiofrequency lesions disconnecting pulmonary veins occurs in approximately 80% of cases 4 months after ablation, with similar rates 5 months after reablation.