Young Choi1, Sunhwa Kim1, Ju Yeol Baek1, Sung-Hwan Kim1, Ju Youn Kim2, Tae-Seok Kim3, Youmi Hwang4, Ji-Hoon Kim4, Sung-Won Jang5, Man Young Lee6, Yong-Seog Oh7. 1. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. 2. Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea. 3. Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea. 4. Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea. 5. Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 6. Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 7. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. oys@catholic.ac.kr.
Abstract
PURPOSE: Organized atrial tachycardia (AT) accounts for a substantial proportion of recurrence after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We sought to analyze the characteristics and long-term outcome of redo RFCA for recurrent AT compared with those for recurrent AF. METHODS: We analyzed 133 patients who underwent prior AF ablation and presented for redo RFCA procedure. Documented rhythm at recurrence was AT in 50 patients (37.6%) and AF in 83 patients (62.4%). Redo ablation was conducted using a stepwise approach in all subjects. RESULTS: Recurrent arrhythmia was more frequently a persistent type in the AT group (70.0% vs. 36.1% in the AT and AF group, respectively, p < 0.001). Fifty mappable ATs were identified in the AT group. Perimitral reentry was most common (19/50), followed by PV-related focal or reentrant tachycardia (16/50). During the redo RFCA, PV reconnection rate and linear ablation rate were similar in the two groups, while the focal target ablation tended to be conducted more frequently in the AF group (26.0% vs. 42.2%, p = 0.060). The AT group showed a higher acute success rate (92.0% vs. 75.9%, p = 0.019) and higher arrhythmia freedom during a mean of 30 months (76.0% vs. 55.4%, p = 0.030), compared with the AF group. The AT group and de novo AF type (paroxysmal) were independent predictors for higher arrhythmia freedom. CONCLUSIONS: RFCA for recurrent AT following AF ablation showed favorable acute and long-term success rates and was associated with superior procedural outcomes compared with those for recurrent AF.
PURPOSE: Organized atrial tachycardia (AT) accounts for a substantial proportion of recurrence after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We sought to analyze the characteristics and long-term outcome of redo RFCA for recurrent AT compared with those for recurrent AF. METHODS: We analyzed 133 patients who underwent prior AF ablation and presented for redo RFCA procedure. Documented rhythm at recurrence was AT in 50 patients (37.6%) and AF in 83 patients (62.4%). Redo ablation was conducted using a stepwise approach in all subjects. RESULTS: Recurrent arrhythmia was more frequently a persistent type in the AT group (70.0% vs. 36.1% in the AT and AF group, respectively, p < 0.001). Fifty mappable ATs were identified in the AT group. Perimitral reentry was most common (19/50), followed by PV-related focal or reentrant tachycardia (16/50). During the redo RFCA, PV reconnection rate and linear ablation rate were similar in the two groups, while the focal target ablation tended to be conducted more frequently in the AF group (26.0% vs. 42.2%, p = 0.060). The AT group showed a higher acute success rate (92.0% vs. 75.9%, p = 0.019) and higher arrhythmia freedom during a mean of 30 months (76.0% vs. 55.4%, p = 0.030), compared with the AF group. The AT group and de novo AF type (paroxysmal) were independent predictors for higher arrhythmia freedom. CONCLUSIONS: RFCA for recurrent AT following AF ablation showed favorable acute and long-term success rates and was associated with superior procedural outcomes compared with those for recurrent AF.