Key result
Silent pulmonary veins at redo AF ablation are not linked to increased major event risk.
Why the study?
At redo AF ablation, pulmonary veins may be isolated or reconnected, but associations between silent versus reconnected PVs and adverse outcomes needed investigation.
Does the finding of silent pulmonary veins at redo AF ablation predict adverse clinical outcomes compared to reconnected pulmonary veins?
Observational (n=467)
No
Does the finding of silent pulmonary veins at redo AF ablation predict adverse clinical outcomes compared to reconnected pulmonary veins?
Effect estimate: aHR 1.04 (95% CI 0.47-2.29)
Absolute Event Rate: 25% vs 13.8%
p-value: p=0.919
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.
Silent PVs at redo AF ablation warrant no management change; leaves open their link to comorbidities in observational cohorts.
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%; p<0.001), had more persistent AF (62.5% vs 41.1%; p=0.005) and had more non-PV ablation performed both at prior ablation procedures and at the analysed redo ablation. The primary outcome occurred more frequently in those with silent PVs (25% vs 13.8%; p=0.053). Arrhythmia recurrence was also more common in the silent PV group (66.7% vs 50.6%; p=0.047). After multivariable adjustment, female sex (aHR 2.35 [95% CI 2.35-3.96]; p=0.001) and ischaemic heart disease (aHR 3.21 [95% CI 1.56-6.62]; p=0.002) were independently associated with the primary outcome, and left atrial enlargement (aHR 1.58 [95% CI 1.20-2.08]; p=0.001) and >1 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.
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Calvert et al. (2024) conducted an 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).
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