BACKGROUND: Atrial fibrillation recurrence after initial long-term success of catheter ablation has been described, yet not well studied. We assessed the electrophysiological findings and outcomes of repeat ablation procedures in this setting. METHODS AND RESULTS: Between 2000 and 2015, 10 378 patients underwent atrial fibrillation ablation and were enrolled in a prospectively maintained data registry. From this registry, we included all 137 consecutive patients who had initial long-term success, defined as freedom from recurrent arrhythmia for >36 months off antiarrhythmics, then underwent repeat ablation for recurrent atrial fibrillation. The median arrhythmia-free period that defined long-term success was 52 months (41-68 months). In redo ablations, reconnection along at least one of the pulmonary veins (PVs) was found in 111 (81%) patients. Reconnection along a left superior, left inferior, right superior, and right inferior PV was found in 64%, 62%, 50%, and 54% of patients, respectively, and were reisolated. Additional non-PV ablations were performed in 127 (92.7%) patients: posterior wall (46%), septal to right PVs (49%), superior vena cava (35%), roof lines (52%), and cavotricuspid isthmus (33%). After a median follow-up of 17 months (5-36.9 months), 103 patients (75%) were arrhythmia free (79 off antiarrhythmics, 24 on antiarrhythmics). CONCLUSIONS: PV reconnection is the most common electrophysiological finding in patients with atrial fibrillation recurrence after long-term success, but with lower rates than what had been reported for early recurrences. In our experience, repeat ablations in this setting involve complex ablation approaches to reisolate the PVs and modify the atrial substrate and are associated with good success rates.
BACKGROUND:Atrial fibrillation recurrence after initial long-term success of catheter ablation has been described, yet not well studied. We assessed the electrophysiological findings and outcomes of repeat ablation procedures in this setting. METHODS AND RESULTS: Between 2000 and 2015, 10 378 patients underwent atrial fibrillation ablation and were enrolled in a prospectively maintained data registry. From this registry, we included all 137 consecutive patients who had initial long-term success, defined as freedom from recurrent arrhythmia for >36 months off antiarrhythmics, then underwent repeat ablation for recurrent atrial fibrillation. The median arrhythmia-free period that defined long-term success was 52 months (41-68 months). In redo ablations, reconnection along at least one of the pulmonary veins (PVs) was found in 111 (81%) patients. Reconnection along a left superior, left inferior, right superior, and right inferior PV was found in 64%, 62%, 50%, and 54% of patients, respectively, and were reisolated. Additional non-PV ablations were performed in 127 (92.7%) patients: posterior wall (46%), septal to right PVs (49%), superior vena cava (35%), roof lines (52%), and cavotricuspid isthmus (33%). After a median follow-up of 17 months (5-36.9 months), 103 patients (75%) were arrhythmia free (79 off antiarrhythmics, 24 on antiarrhythmics). CONCLUSIONS: PV reconnection is the most common electrophysiological finding in patients with atrial fibrillation recurrence after long-term success, but with lower rates than what had been reported for early recurrences. In our experience, repeat ablations in this setting involve complex ablation approaches to reisolate the PVs and modify the atrial substrate and are associated with good success rates.
Authors: Jamario Skeete; Parikshit S Sharma; David Kenigsberg; Grzegorz Pietrasik; Ahmed F Osman; Venkatesh Ravi; Jeanne M Du-Fay-de-Lavallaz; Zoe Post; Jeremiah Wasserlauf; Timothy R Larsen; Kousik Krishnan; Richard Trohman; Henry D Huang Journal: J Arrhythm Date: 2022-05-06
Authors: Michael A Labarbera; Thomas Atta-Fosu; Albert K Feeny; Marjan Firouznia; Meghan Mchale; Catherine Cantlay; Tyler Roach; Alexis Axtell; Paul Schoenhagen; John Barnard; Jonathan D Smith; David R Van Wagoner; Anant Madabhushi; Mina K Chung Journal: IEEE J Transl Eng Health Med Date: 2021-12-09
Authors: Makoto Sano; Christian-Hendrik Heeger; Vanessa Sciacca; Niels Große; Ahmad Keelani; Behzad Hassan Hosseiny Fahimi; Huong Lan Phan; Samuel Reincke; Ben Brüggemann; Thomas Fink; Spyridon Liosis; Julia Vogler; Charlotte Eitel; Roland Richard Tilz Journal: J Interv Card Electrophysiol Date: 2020-07-07 Impact factor: 1.900
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
Authors: Gaëlle Vermeersch; Juan-Pablo Abugattas; Varnavas Varnavas; Jeroen De Cocker; Bruno Schwagten; Juan Sieira; Carlo de Asmundis; Gian-Battista Chierchia; Yves De Greef Journal: J Arrhythm Date: 2021-03-26