Catheter ablation targeting inducible atrial arrhythmias achieved freedom from any arrhythmia in 53% of patients with recurrent paroxysmal atrial fibrillation despite isolated pulmonary veins.
Observational (n=21)
Does catheter ablation targeting inducible atrial arrhythmias improve freedom from arrhythmia in patients with recurrent PAF despite isolated pulmonary veins?
In patients with recurrent PAF despite isolated pulmonary veins, an ablation strategy targeting inducible atrial arrhythmias achieved freedom from arrhythmia in 53% of patients at 21 months.
AIMS: Pulmonary vein isolation (PVI) is an effective treatment option for paroxysmal atrial fibrillation (PAF). Reconnection of pulmonary veins (PVs) is the predominant cause for recurrence of PAF. However, treatment of patients with recurrence of PAF despite isolated PV in the absence of extra-PV foci remains challenging. METHODS AND RESULTS: Of 265 patients undergoing repeat catheter ablation (CA) for recurrence of PAF 21 (8%) patients (14 men, age 58 ± 14 years) showed no reconnection of PV. Therefore, inducibility of sustained atrial arrhythmias was tested. If sustained atrial fibrillation (AF) or sustained atrial tachycardia (AT) was induced, patients underwent CA. During follow-up (FU), Holter- and Tele-electrocardiogram were performed. In 19 (91%) of 21 patients, sustained atrial arrhythmias 16 (84%) AF; 3 (15%) patients AT were induced. One patient showed PAF. Eighteen patients underwent CA aiming for termination of induced arrhythmia. In 14 (77%) patients, termination into sinus rhythm was achieved. Despite extensive CA, three (16%) patients were externally cardioverted. No periprocedural complications occurred. During 21.2 ± 6.8-month FU, 10 (53%) patients were free of any arrhythmia. Paroxysmal atrial fibrillation recurred in 4 (21%) and AT in 5 (26%) patients. One patient showed persistent AF. Repeat CA was scheduled and successfully performed for these patients. CONCLUSION: In patients with recurrence of PAF despite isolated PV, termination of induced atrial arrhythmias can be achieved in most patients by defragmentation and AT ablation. Moreover, this ablation strategy results in favourable mid-term outcome results.
Sultan et al. (2015) conducted an observational in Recurrent paroxysmal atrial fibrillation despite isolated pulmonary veins (n=21). Catheter ablation targeting inducible atrial arrhythmias was evaluated on Freedom from any arrhythmia. Catheter ablation targeting inducible atrial arrhythmias achieved freedom from any arrhythmia in 53% of patients with recurrent paroxysmal atrial fibrillation despite isolated pulmonary veins.