OBJECTIVES: This study sought to determine the prevalence of patients with 4 isolated veins at repeat ablation after "CLOSE" -guided pulmonary vein isolation (PVI), a strategy based on delivery of contiguous and optimized radiofrequency lesions. BACKGROUND: The likelihood of finding 4 isolated veins at a repeat ablation for atrial fibrillation (AF) recurrence after a first PVI is low. METHODS: Patients undergoing repeat ablation for AF recurrence after first CLOSE-guided PVI were included. At repeat: 1) the status of the PV was evaluated; and 2) high-density voltage mapping was performed. In case of pulmonary vein reconnection (PVR), veins were reisolated. In patients with 4 isolated veins, empirical trigger or substrate ablation was performed. RESULTS: Of 326 patients undergoing CLOSE-guided PVI for paroxysmal AF, 45 patients underwent repeat ablation for AF recurrence (11 ± 7 months after first PVI). In 28 patients, all veins were still isolated (62%). They showed similar clinical characteristics and similar time from first PVI to AF recurrence (8 ± 7 vs. 6 ± 6 months, respectively, p = 0.453) compared with patients with PVR. In contrast, they were characterized by a higher incidence of low voltage (57% vs. 17%, p = 0.033). Patients with 4 isolated veins, compared with patients treated for PVR, showed a lower 12-month freedom from AF after repeat ablation (61% vs. 88%, p = 0.045). CONCLUSIONS: After CLOSE-guided ablation, PVR is no longer the rule in patients with AF recurrence. Patients with AF recurrence and 4 isolated veins present with a similar clinical profile and time to recurrence as patients with PVR.
OBJECTIVES: This study sought to determine the prevalence of patients with 4 isolated veins at repeat ablation after "CLOSE" -guided pulmonary vein isolation (PVI), a strategy based on delivery of contiguous and optimized radiofrequency lesions. BACKGROUND: The likelihood of finding 4 isolated veins at a repeat ablation for atrial fibrillation (AF) recurrence after a first PVI is low. METHODS:Patients undergoing repeat ablation for AF recurrence after first CLOSE-guided PVI were included. At repeat: 1) the status of the PV was evaluated; and 2) high-density voltage mapping was performed. In case of pulmonary vein reconnection (PVR), veins were reisolated. In patients with 4 isolated veins, empirical trigger or substrate ablation was performed. RESULTS: Of 326 patients undergoing CLOSE-guided PVI for paroxysmal AF, 45 patients underwent repeat ablation for AF recurrence (11 ± 7 months after first PVI). In 28 patients, all veins were still isolated (62%). They showed similar clinical characteristics and similar time from first PVI to AF recurrence (8 ± 7 vs. 6 ± 6 months, respectively, p = 0.453) compared with patients with PVR. In contrast, they were characterized by a higher incidence of low voltage (57% vs. 17%, p = 0.033). Patients with 4 isolated veins, compared with patients treated for PVR, showed a lower 12-month freedom from AF after repeat ablation (61% vs. 88%, p = 0.045). CONCLUSIONS: After CLOSE-guided ablation, PVR is no longer the rule in patients with AF recurrence. Patients with AF recurrence and 4 isolated veins present with a similar clinical profile and time to recurrence as patients with PVR.
Authors: Leon Iden; Sonia Busch; Daniel Steven; Roland R Tilz; Dong-In Shin; K R Julian Chun; Heidi Estner; Felix Bourier; David Duncker; Philipp Sommer; Andreas Metzner; Tilman Maurer; Nils-Christian Ewertsen; Henning Jansen; Andreas Rillig; Victoria Johnson; Till Althoff Journal: Herzschrittmacherther Elektrophysiol Date: 2021-07-26
Authors: Pedro A Sousa; Luís Puga; Luís Adão; João Primo; Ziad Khoueiry; Ana Lebreiro; Paulo Fonseca; Philippe Lagrange; Luís Elvas; Lino Gonçalves Journal: J Arrhythm Date: 2022-03-15
Authors: Mark J Mulder; Michiel J B Kemme; Amaya M D Hagen; Luuk H G A Hopman; Peter M van de Ven; Herbert A Hauer; Giovanni J M Tahapary; Marco J W Götte; Albert C van Rossum; Cornelis P Allaart Journal: Int J Cardiol Heart Vasc Date: 2020-07-03
Authors: Gábor Orbán; Zoltán Salló; Péter Perge; Pál Ábrahám; Katalin Piros; Klaudia Vivien Nagy; István Osztheimer; Béla Merkely; László Gellér; Nándor Szegedi Journal: Front Cardiovasc Med Date: 2022-07-13
Authors: Bart A Mulder; Meelad I H Al-Jazairi; Federico T Magni; Hessel F Groenveld; Robert G Tieleman; Ans C P Wiesfeld; Yong E S Tan; Isabelle C Van Gelder; Michiel Rienstra; Yuri Blaauw Journal: Open Heart Date: 2021-12