BACKGROUND: Ablation is more successful for patients with paroxysmal atrial fibrillation (AF1) than for those with persistent (AF2) or longstanding persistent AF (AF3). Many patients fail initial ablation and undergo repeat ablations. Little is known about repeat ablation procedure times, complications, and outcomes. METHODS: We evaluated Kaplan-Meier freedom from AF by AF type and sex for initial and repeat ablations and for final status of 843 patients undergoing 1122 ablations. We examined complications, procedure times and reasons why patients do not undergo repeat ablations. Cox multivariate analysis evaluated factors predicting ablation failure. RESULTS: Initial ablations were more successful in AF1 than AF2 or AF3 (P < .0001) patients. For each AF type, repeat ablations were more successful than initial ablations (P = .01 to <.001). Procedure times (139.1 ± 49.1 vs 135.3 ± 45.6 minutes, P = .248) and major complications (1.66% vs 2.87%, P = .216) were similar. Women had different clinical characteristics than men, similar initial and repeat ablation success rates but lower overall success because of fewer repeat ablations (57.8% vs 68.2%, P = .047) due to patient choice (P = .028). Patients with either successful initial ablations or undergoing repeat ablations had late AF recurrence rates of 0% to 1.5% a year. Age (P = .012), larger left atria (P = .002), female sex (P = .001), AF2 (P < .0001), AF3 (P = .003), and coronary disease (P = .003) predicted failure. CONCLUSIONS: Repeat ablations are more successful than initial ablations, have similar procedure times and complication rates, help determine final success rates, and may explain sex difference in success rates. For the best outcomes, patients should assume that a repeat ablation may be required to eliminate AF.
BACKGROUND: Ablation is more successful for patients with paroxysmal atrial fibrillation (AF1) than for those with persistent (AF2) or longstanding persistent AF (AF3). Many patients fail initial ablation and undergo repeat ablations. Little is known about repeat ablation procedure times, complications, and outcomes. METHODS: We evaluated Kaplan-Meier freedom from AF by AF type and sex for initial and repeat ablations and for final status of 843 patients undergoing 1122 ablations. We examined complications, procedure times and reasons why patients do not undergo repeat ablations. Cox multivariate analysis evaluated factors predicting ablation failure. RESULTS: Initial ablations were more successful in AF1 than AF2 or AF3 (P < .0001) patients. For each AF type, repeat ablations were more successful than initial ablations (P = .01 to <.001). Procedure times (139.1 ± 49.1 vs 135.3 ± 45.6 minutes, P = .248) and major complications (1.66% vs 2.87%, P = .216) were similar. Women had different clinical characteristics than men, similar initial and repeat ablation success rates but lower overall success because of fewer repeat ablations (57.8% vs 68.2%, P = .047) due to patient choice (P = .028). Patients with either successful initial ablations or undergoing repeat ablations had late AF recurrence rates of 0% to 1.5% a year. Age (P = .012), larger left atria (P = .002), female sex (P = .001), AF2 (P < .0001), AF3 (P = .003), and coronary disease (P = .003) predicted failure. CONCLUSIONS: Repeat ablations are more successful than initial ablations, have similar procedure times and complication rates, help determine final success rates, and may explain sex difference in success rates. For the best outcomes, patients should assume that a repeat ablation may be required to eliminate AF.
Authors: Willy Weng; David H Birnie; F Daniel Ramirez; Cassidy Van Stiphout; Mehrdad Golian; Pablo B Nery; Simon P Hansom; Calum J Redpath; Andres Klein; Girish M Nair; Wael Alqarawi; Martin S Green; Darryl R Davis; Pasquale Santangeli; Robert D Schaller; Francis E Marchlinski; Mouhannad M Sadek Journal: J Interv Card Electrophysiol Date: 2022-04-03 Impact factor: 1.900
Authors: Irina A Polejaeva; Ravi Ranjan; Christopher J Davies; Misha Regouski; Justin Hall; Aaron L Olsen; Qinggang Meng; Heloisa M Rutigliano; Derek J Dosdall; Nathan A Angel; Frank B Sachse; Thomas Seidel; Aaron J Thomas; Rusty Stott; Kip E Panter; Pamela M Lee; Arnaud J Van Wettere; John R Stevens; Zhongde Wang; Rob S MacLeod; Nassir F Marrouche; Kenneth L White Journal: J Cardiovasc Electrophysiol Date: 2016-08-30
Authors: Roger A Winkle; R Hardwin Mead; Gregory Engel; Melissa H Kong; Rob A Patrawala Journal: J Interv Card Electrophysiol Date: 2012-02-28 Impact factor: 1.900
Authors: Shinwan Kany; Johannes Brachmann; Thorsten Lewalter; Karl-Heinz Kuck; Dietrich Andresen; Stephan Willems; Ellen Hoffmann; Lars Eckardt; Dierk Thomas; Matthias Hochadel; Jochen Senges; Andreas Metzner; Andreas Rillig Journal: Clin Res Cardiol Date: 2020-10-28 Impact factor: 5.460
Authors: Anand N Ganesan; Nicholas J Shipp; Anthony G Brooks; Pawel Kuklik; Dennis H Lau; Han S Lim; Thomas Sullivan; Kurt C Roberts-Thomson; Prashanthan Sanders Journal: J Am Heart Assoc Date: 2013-03-18 Impact factor: 5.501
Authors: Roger A Winkle; R Hardwin Mead; Gregory Engel; Melissa H Kong; Rob A Patrawala Journal: J Interv Card Electrophysiol Date: 2013-03-14 Impact factor: 1.900