Key result
More extensive pulmonary vein reconnections at repeat ablation were moderately correlated with earlier atrial fibrillation recurrence (r = -0.32, P = 0.005) in patients who had previously undergone duty-cycled radiofrequency ablation.
Why the study?
Although PVI with multielectrode duty-cycled radiofrequency is effective for AF, the characteristics of PV reconnection at repeat ablation and their correlation with the timing of AF recurrence remained to be described.
Does the pattern of pulmonary vein reconnections affect the time of atrial fibrillation recurrence after duty-cycled radiofrequency ablation?
Observational (n=85)
No
Does the pattern of pulmonary vein reconnections affect the time of atrial fibrillation recurrence after duty-cycled radiofrequency ablation?
Effect estimate: r = -0.32
p-value: p=0.005
In patients with recurrent AF after duty-cycled radiofrequency ablation, more extensive pulmonary vein reconnections correlate with earlier AF recurrence, whereas patients without reconnections tend to have early recurrences likely driven by non-PV triggers.
PV reconnection extent was associated with AF recurrence timing after duty-cycled ablation; hypothesis-generating for non-PV triggers when reconnections absent.
BACKGROUND: Pulmonary vein isolation (PVI) with multielectrode duty-cycled radiofrequency (PVAC) has been shown to be effective in the treatment of atrial fibrillation (AF). We describe pulmonary vein (PV) reconnection at repeat ablation in patients with AF recurrence after PVAC PVI and analyze the correlation between the time of AF recurrence and the observed PV reconnection patterns. METHODS: Eighty-five patients undergoing a redo PVI for recurrent AF 9.2 ± 3.8 months after an initial PVAC PVI procedure was retrospectively enrolled. RESULTS: A total of 93% had PV reconnections with a mean of 2.97 ± 1.2 reconnected PVs/patients and 75% of formerly isolated PVs were found reconnected. The highest reconnection rates (94%) were observed for left common trunks (CTs). A total of 33% patients had three and four reconnected PVs, respectively, while 7% were without PV reconnection. There was a moderate but significant negative correlation between the time of AF recurrences and the extending of PV reconnections at redo PVI for patients with proven PV reconnection (r = -0.32, P = 0.005), whereas five out of six patients without PV reconnection had recurrences within the first 9 months after PVI. CONCLUSIONS: At redo ablation most patients with recurrence of AF after PVAC PVI had PV reconnection(s). Patients with PV reconnection(s) showed a moderate negative correlation between the number of reconnected PVs and the time of AF recurrence with more extensive PV reconnections resulting in earlier PV recurrences after the blanking period. Patients without PV reconnection experienced early AF recurrences, indicating non-PV triggers contribute to AF recurrences in these patients.
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Wieczorek et al. (2020) conducted an observational in Recurrent atrial fibrillation (n=85). Pulmonary vein reconnection vs. Fewer or no reconnected pulmonary veins was evaluated on Correlation between the time of AF recurrence and the extending of PV reconnections at redo PVI (r = -0.32, p=0.005). More extensive pulmonary vein reconnections at repeat ablation were moderately correlated with earlier atrial fibrillation recurrence (r = -0.32, P = 0.005) in patients who had previously undergone duty-cycled radiofrequency ablation.
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