INTRODUCTION: Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized. METHODS AND RESULTS: All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6%) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41%) had 4 reconnected PVs, 27 (16%) had 3, 31 (18%) had 2, and 29 (17%) had 1. Only 13 (8%) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50%), and reproducible PV APDs in 28 (22%). Thirty-six (20%) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47%) had no AF off antiarrhythmic drugs (AAD); 28 (21%) had no AF with AAD; and 18 (13%) had rare AF with good symptom control; 26 patients (19%) had recurrent AF. CONCLUSIONS: At time of third or greater AF ablation, PV reconnection is the rule (92%) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81% of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.
INTRODUCTION: Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized. METHODS AND RESULTS: All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6%) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41%) had 4 reconnected PVs, 27 (16%) had 3, 31 (18%) had 2, and 29 (17%) had 1. Only 13 (8%) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50%), and reproducible PV APDs in 28 (22%). Thirty-six (20%) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47%) had no AF off antiarrhythmic drugs (AAD); 28 (21%) had no AF with AAD; and 18 (13%) had rare AF with good symptom control; 26 patients (19%) had recurrent AF. CONCLUSIONS: At time of third or greater AF ablation, PV reconnection is the rule (92%) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81% of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.
Authors: Ki-Hun Kim; Sanghamitra Mohanty; Prasant Mohanty; Chintan Trivedi; Eli Hamilton Morris; Pasquale Santangeli; Rong Bai; Amin Al-Ahmad; John David Burkhardt; Joseph G Gallinghouse; Rodney Horton; Javier E Sanchez; Shane Bailey; Patrick M Hranitzky; Jason Zagrodzky; Soo G Kim; Luigi Di Biase; Andrea Natale Journal: J Interv Card Electrophysiol Date: 2017-03-07 Impact factor: 1.900
Authors: Arash Aryana; Sheldon M Singh; Giacomo Mugnai; Carlo de Asmundis; Marcin Kowalski; Deep K Pujara; Andrew I Cohen; Steve K Singh; Charles E Fuenzalida; Nelson Prager; Mark R Bowers; Padraig Gearoid O'Neill; Pedro Brugada; André d'Avila; Gian-Battista Chierchia Journal: J Interv Card Electrophysiol Date: 2016-07-30 Impact factor: 1.900
Authors: Gustavo R Goldenberg; Masa Ono; Arash Aryana; Andre d'Avila; Eduardo B Saad; Steve K Singh; Sheldon M Singh Journal: J Interv Card Electrophysiol Date: 2016-10-20 Impact factor: 1.900
Authors: Juan-Pablo Abugattas; Bruno Schwagten; Jeroen De Cocker; Hugo-Enrique Coutiño; Francesca Salghetti; Varnavas Varnavas; Erwin Ströker; Juan Sieira; Michael Wolf; Pedro Brugada; Carlo de Asmundis; Gian-Battista Chierchia; Yves De Greef Journal: J Atr Fibrillation Date: 2019-02-28
Authors: Graham Peigh; Jeremiah Wasserlauf; Rachel M Kaplan; Ansel P Amaral; Amar Trivedi; Alexandru B Chicos; Rishi Arora; Susan Kim; Albert Lin; Nishant Verma; Bradley P Knight; Rod S Passman Journal: J Cardiovasc Electrophysiol Date: 2020-03-09 Impact factor: 2.942