Key result
Cardiovascular comorbidities increased 10-year arrhythmia recurrence (51% vs 31%), while redo ablation of non-pulmonary vein triggers yielded >91% freedom from arrhythmia at 2 years (P<0.001).
Why the study?
The long-term outcome, time to recurrence, and prevalent triggering foci at repeat ablation after isolation of pulmonary veins, left atrial posterior wall, and superior vena cava in paroxysmal AF with or without comorbidities needed evaluation.
What is the long-term rate and mechanism of arrhythmia recurrence after successful isolation of pulmonary veins, posterior wall, and SVC in paroxysmal AF patients with and without comorbidities?
Cohort (n=1,633)
Yes
What is the long-term rate and mechanism of arrhythmia recurrence after successful isolation of pulmonary veins, posterior wall, and SVC in paroxysmal AF patients with and without comorbidities?
Very late recurrence of AF after successful extensive isolation is primarily driven by non-pulmonary vein triggers, and targeting these foci (LAA/CS) during redo ablation yields high success rates, though comorbidities accelerate recurrence.
Answers are grounded in this paper and cite their sources.
May support LAA/CS isolation in redo ablation for very late AF recurrence; leaves open efficacy in randomized trials.
Background We evaluated long‐term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities. Methods and Results A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia‐free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidities); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10 years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3–8.5) and 5.6 (IQI 3.8–8.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147/201 and 414/456 received left atrial appendage and coronary sinus isolation and 54/201 and 42/456 had left atrial lines and flutter ablation. At 2 years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage/coronary sinus isolation remained arrhythmia‐free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation ( P <0.001). Conclusions Very late recurrence of atrial fibrillation after successful isolation of pulmonary veins, regardless of the comorbidity profile, was majorly driven by non‐pulmonary vein triggers and ablation of these foci resulted in high success rate. However, presence of comorbidities was associated with significantly earlier recurrence.
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Mohanty et al. (2021) conducted a cohort in Paroxysmal atrial fibrillation (n=1,633). Cardiovascular comorbidities vs. No cardiovascular comorbidities was evaluated on Arrhythmia recurrence at 10 years. Cardiovascular comorbidities increased 10-year arrhythmia recurrence (51% vs 31%), while redo ablation of non-pulmonary vein triggers yielded >91% freedom from arrhythmia at 2 years (P<0.001).
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