Key result
First-pass isolation predicts PV non-reconnection yet links to ~13% lower 1-year AT recurrence-free rates.
Why the study?
Whether first-pass isolation (FPI) marks durable pulmonary vein isolation remained unconfirmed, and outcomes after a second ablation targeting non-PV triggers in patients without PV reconnection were unclear.
Does first-pass isolation predict pulmonary vein non-reconnection, and how do outcomes compare after a second ablation procedure between patients with and without PV reconnection?
Cohort (n=309)
Does first-pass isolation predict pulmonary vein non-reconnection, and how do outcomes compare after a second ablation procedure between patients with and without PV reconnection?
Odds Ratio: 3.71 (95% CI 2.23–6.19)
p-value: p=<0.001
First-pass isolation strongly predicts durable pulmonary vein isolation, but patients requiring a second procedure without PV reconnection have worse outcomes despite aggressive ablation of non-PV triggers.
Challenges first-pass isolation as a durability marker; leaves open non-PV mechanisms driving worse outcomes in non-reconnected veins.
INTRODUCTION: Although first-pass isolation (FPI) of the pulmonary vein (PV) has been suggested as a marker for PV isolation (PVI) durability, it has not been confirmed. Non-PV atrial fibrillation (AF) triggers were the main target in patients without PV reconnection in the second ablation procedure, but the outcome was unclear. We aimed to validate FPI as a marker of PVI durability and evaluate the outcome after the second procedure in patients without PV reconnection by comparing it to those with reconnection. METHODS: Among the 2087 patients undergoing the first ablation index-guided radiofrequency AF ablation, 309 with atrial tachyarrhythmias (ATs) recurrence and undergoing the second procedure were studied. Clinical characteristics and outcomes were compared between the patients without PV reconnection (PV non-reconnection group, n = 142) and with reconnection (PV reconnection group, n = 167). RESULTS: FPI in both PV sides in the first ablation procedure was significantly more frequent in the PV non-reconnection group (77.5%) than in the PV reconnection group (45.5%) (p < .001). Multivariate logistic regression analysis revealed that FPI (odds ratio, 3.71 [95% confidence interval, 2.23-6.19], p < .001) was the only predictor of PV non-reconnection. Radiofrequency applications for non-PV AF triggers were more frequently performed in the PV non-reconnection group (40.8% vs. 24.6%, respectively, p < .001). Kaplan-Meier analysis revealed that AT recurrence-free rate was significantly lower in the PV non-reconnection group (1-year recurrence-free rate, 62.7% vs. 75.4%, respectively; p = .01 by log-rank test). CONCLUSION: FPI was the only independent predictor of PV non-reconnection. Despite aggressive ablation for non-PV triggers, AT recurrence was more frequent in patients with PV non-reconnection.
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Okamatsu et al. (2023) conducted a cohort in Atrial fibrillation (n=309). First-pass isolation (FPI) vs. No FPI was evaluated on Pulmonary vein non-reconnection (OR 3.71, 95% CI 2.23-6.19, p=<0.001). First-pass isolation independently predicted pulmonary vein non-reconnection (OR 3.71; 95% CI 2.23-6.19), but patients with non-reconnection had a lower 1-year AT recurrence-free rate (62.7% vs 75.4%).
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