Key result
Segmental PVI is linked to similar AF-free survival as circumferential isolation but ~10% more atrial flutter.
Why the study?
CPVI has supplanted SPVI as the standard AF ablation procedure, but limited evidence examines the efficacy of these strategies in redo ablations.
Does segmental pulmonary vein isolation compared to circumferential pulmonary vein isolation improve arrhythmia-free survival in patients undergoing redo atrial fibrillation ablation?
Cohort (n=141)
Does segmental pulmonary vein isolation compared to circumferential pulmonary vein isolation improve arrhythmia-free survival in patients undergoing redo atrial fibrillation ablation?
Absolute Event Rate: 53.3% vs 56.9%
p-value: p=0.700
In redo atrial fibrillation ablation, SPVI and CPVI provide similar AF-free survival, but SPVI is associated with a higher long-term recurrence of atrial flutter.
SPVI may yield similar AF-free survival yet higher flutter recurrence in redo ablation; hypothesis-generating and should not yet change practice.
BACKGROUND: Circumferential pulmonary vein isolation (CPVI) has supplanted segmental PVI (SPVI) as standard procedure for atrial fibrillation (AF). However, there is limited evidence examining the efficacy of these strategies in redo ablations. In this study, we investigated the difference in recurrence rates between SPVI and CPVI in redo ablations for PV reconnection. METHODS AND RESULTS: This study retrospectively enrolled 543 patients who had undergone AF ablation between 2015 and 2017. Among them, 167 patients (30.8%, including 128 male patients and 100 patients with paroxysmal AF) underwent redo ablation for recurrent AF. Excluding 26 patients without PV reconnection, 141 patients [90 patients of SPVI (Group 1) and 51 patients of CPVI (Group 2)] were included. The AF-free survival rates were 53.3% and 56.9% in Group 1 and Group 2, respectively (P=0.700). The atrial flutter (AFL)-free survival rates were 90% and 100% in Group 1 and Group 2, respectively (P=0.036). The ablation time was similar between groups, and there no major complications were observed. CONCLUSIONS: For redo AF ablation procedures, SPVI and CPVI showed similar outcomes, except for a higher AFL recurrence rate for SPVI after long-term follow-up (>2 years). This may be due to a higher probability of residual PV gaps causing reentrant AFL.
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Wu et al. (2023) conducted a cohort in Recurrent atrial fibrillation (n=141). Segmental pulmonary vein isolation (SPVI) vs. Circumferential pulmonary vein isolation (CPVI) was evaluated on AF-free survival (p=0.700). Segmental pulmonary vein isolation resulted in similar AF-free survival compared to circumferential isolation (53.3% vs 56.9%, P=0.700) but lower atrial flutter-free survival (90% vs 100%, P=0.036).
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