A strategy of waiting 30 minutes after initial pulmonary vein isolation and reablating for early reconnection did not significantly improve sinus rhythm maintenance compared to immediate termination (70.1% vs 60.9%; P=0.13).
Cohort (n=272)
Does waiting 30 minutes to monitor for and ablate early pulmonary vein reconnection reduce late arrhythmia recurrence in patients with paroxysmal AF undergoing PVI?
Waiting 30 minutes after PVI to check for and ablate early pulmonary vein reconnection does not significantly improve long-term sinus rhythm maintenance compared to immediate termination.
Absolute Event Rate: 70.1% vs 60.9%
p-value: p=0.13
AIM: The objective of the study was to investigate whether early pulmonary vein reconnection (PVR) is a predictor of late arrhythmia recurrence after a single ablation procedure for paroxysmal atrial fibrillation (AF). Further ablation was delivered to patients with acute PVR to test whether this strategy could reduce recurrences. METHODS AND RESULTS: One hundred and forty-four consecutive patients with symptomatic, drug-refractory paroxysmal AF, undergoing pulmonary vein isolation (PVI), were assigned to the 'PVR30 test' group, where PVR was monitored for 30 min after initial PVI and further ablation was applied if needed, and compared with a control group of 128 patients, where the procedure was terminated after initial successful isolation. During a mean follow-up of 17.7 months, sinus rhythm was maintained in 101 patients in the 'PVR30 test' group (70.1%) vs. 78 in the control group (60.9%) (P = 0.13). Among patients with acute PVR and reablation after 30 min, the recurrence rate was 45.3 vs. 39.1% in the control group (P = 0.47). Multivariable logistic regression analysis showed that PVR was independently associated with AF recurrence (adjusted hazard ratio 4.7, 95% confidence interval 1.8-12.2), along with left atrial diameter (adjusted hazard ratio 1.3/mm of higher diameter, 95% confidence interval 1.2-1.4). CONCLUSION: In patients with paroxysmal AF undergoing a single ablation procedure, PVR 30 min after the initial PVI is associated with late AF recurrence. However, the strategy of 30 min waiting and reablating does not appear to be superior to immediate termination of the procedure after initial PVI.
Efremidis et al. (Mon,) conducted a cohort in symptomatic, drug-refractory paroxysmal atrial fibrillation (n=272). 30-minute waiting and reablation for early pulmonary vein reconnection vs. Immediate termination after initial successful isolation was evaluated on Maintenance of sinus rhythm (p=0.13). A strategy of waiting 30 minutes after initial pulmonary vein isolation and reablating for early reconnection did not significantly improve sinus rhythm maintenance compared to immediate termination (70.1% vs 60.9%; P=0.13).
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