Differential Clinical Characteristics and Prognosis of Patients with Longstanding Persistent Atrial Fibrillation Presenting with Recurrent Atrial Tachycardia versus Recurrent Atrial Fibrillation After First Ablation

BACKGROUND: It is unknown if baseline characteristics and prognosis of patients with longstanding persistent (defined as history greater than 1 year) atrial fibrillation (LS-AF) differ among those with either recurrent atrial tachycardia (R-AT) or recurrent AF (R-AF) after first ablation. METHODS: In 222 consecutive LS-AF patients treated for R-AT or R-AF after first ablation, activation and entrainment mapping was used to identify R-AT mechanism and to guide the following ablation, and the ablation endpoints for all patients included complete pulmonary vein isolation, bidirectional block of lines, and disappearance of complex fractionated atrial electrograms. RESULTS: There were 102 patients in the R-AF group. LS-AF patients with R-AT as compared to R-AF had shorter AF duration and recurrence interval, smaller left atrium size and left ventricular end-diastolic diameter, and less mitral and aortic regurgitation before first ablation. During follow-up (17.7 ± 4.0 months) after R-AT/R-AF ablation, 78 LS-AF patients developed recurrent atrial tachyarrhythmia, with lower overall and recurrence as AF in R-AT versus R-AF groups. CONCLUSIONS: LS-AF patients who develop R-AT versus R-AF after first ablation have more favorable baseline characteristics and prognosis.