Gustavo R Goldenberg1, Masa Ono2, Arash Aryana3, Andre d'Avila4, Eduardo B Saad5, Steve K Singh6, Sheldon M Singh7. 1. Schulich Heart Program, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. 2. Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA. 3. Mercy General Hospital and Dignity Health Heart & Vascular Institute, Sacramento, CA, USA. 4. Instituto de Pesquisa em Arritmia Cardiaca - Hospital Cardiologico, Florianopolis, SC, Brazil. 5. Center for Atrial Fibrillation, Hospital Pro-Cardiaco, Rio de Janeiro, RJ, Brazil. 6. Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA. 7. Schulich Heart Program, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. sheldon.singh@sunnybrook.ca.
Abstract
PURPOSE: Atrial fibrillation (AF) recurrence after an initial persistent AF ablation procedure is high, frequently resulting in the need for a repeat AF ablation procedure. Guidance on the optimal strategy for repeat procedures is non-existent. The objective of this study was to compare the freedom from recurrent atrial arrhythmia associated with two strategies for repeat persistent AF ablation procedure: (1) pulmonary vein re-isolation alone and (2) non-pulmonary vein LA ablation in addition to pulmonary vein re-isolation. METHODS: A retrospective multi-center case-controlled study was undertaken. Time-to-recurrent AF with each strategy was assessed using Kaplan-Meier curves. A Cox proportional-hazards regression model was used to determine time-dependent predictors of recurrent AF after the repeat procedure in the entire cohort. RESULTS: Ninety-eight patients were included in the cohort-39 patients who did not undergo additional LA ablation and 59 patients who had did. AF after the repeat procedure occurred in 38 % of the cohort during a mean follow-up of 18 ± 11 months. Additional LA ablation at the repeat procedure was not associated with a less arrhythmia recurrence (HR = 1.55, p = 0.28). The only variable associated with arrhythmia recurrence after the repeat procedure was additional LA ablation during the initial ablation procedure (HR = 4.13, p = 0.005). CONCLUSIONS: LA ablation in addition to pulmonary vein re-isolation during a repeat persistent AF ablation procedure was not associated with reduced arrhythmia recurrence after a repeat persistent AF ablation procedure.
PURPOSE:Atrial fibrillation (AF) recurrence after an initial persistent AF ablation procedure is high, frequently resulting in the need for a repeat AF ablation procedure. Guidance on the optimal strategy for repeat procedures is non-existent. The objective of this study was to compare the freedom from recurrent atrial arrhythmia associated with two strategies for repeat persistent AF ablation procedure: (1) pulmonary vein re-isolation alone and (2) non-pulmonary vein LA ablation in addition to pulmonary vein re-isolation. METHODS: A retrospective multi-center case-controlled study was undertaken. Time-to-recurrent AF with each strategy was assessed using Kaplan-Meier curves. A Cox proportional-hazards regression model was used to determine time-dependent predictors of recurrent AF after the repeat procedure in the entire cohort. RESULTS: Ninety-eight patients were included in the cohort-39 patients who did not undergo additional LA ablation and 59 patients who had did. AF after the repeat procedure occurred in 38 % of the cohort during a mean follow-up of 18 ± 11 months. Additional LA ablation at the repeat procedure was not associated with a less arrhythmia recurrence (HR = 1.55, p = 0.28). The only variable associated with arrhythmia recurrence after the repeat procedure was additional LA ablation during the initial ablation procedure (HR = 4.13, p = 0.005). CONCLUSIONS: LA ablation in addition to pulmonary vein re-isolation during a repeat persistent AF ablation procedure was not associated with reduced arrhythmia recurrence after a repeat persistent AF ablation procedure.
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