A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation

Robin Wesselink, Mindy Vroomen, Ingrid Overeinder, Jolien Neefs, Nicoline We van den Berg, Eva R Meulendijks, Femke R Piersma, Rushd Fm Al-Shama, Tim Ac de Vries, Tom E Verstraelen, Justin Luermans, Bart Maesen, Carlo de Asmundis, Gian-Battista Chierchia, Mark La Meir, Laurent Afg Pison, Wim Jp van Boven, Antoine Hg Driessen, Joris R de Groot

Research output: Contribution to journalArticlepeer-review


INTRODUCTION AND OBJECTIVES: Recent observations suggest that patients with a previous failed catheter ablation have an increased risk of atrial fibrillation (AF) recurrence after subsequent thoracoscopic AF ablation. We assessed the risk of AF recurrence in patients with a previous failed catheter ablation undergoing thoracoscopic ablation.

METHODS:  We included patients from 3 medical centers. To correct for potential heterogeneity, we performed propensity matching to compare AF freedom (freedom from any atrial tachyarrhythmia > 30 s during a 1-year follow-up). Left atrial appendage tissue was analyzed for collagen distribution.

RESULTS: A total of 705 patients were included, and 183 had a previous failed catheter ablation. These patients had fewer risk factors for AF recurrence than ablation naïve controls: smaller indexed left atrial volume (40.9 ± 12.5 vs 43.0 ± 12.5 mL/m2, P = .048), less congestive heart failure (1.5% vs 8.9%, P = .001), and less persistent AF (52.2% vs 60.3%, P = .067). However, AF history duration was longer in patients with a previous failed catheter ablation (6.5 [4-10.5] vs 4 [2-8] years; P < .001). In propensity matched analysis, patients with a failed catheter ablation were at a 68% higher AF recurrence risk (OR: 1.68 [1.20-2.15], P = .034). AF freedom was 61.1% in patients with a previous failed catheter ablation vs 72.5% in ablation naïve matched controls. On histology of the left atrial appendage (n = 198), patients with a failed catheter ablation had a higher density of collagen fibers.

CONCLUSIONS: Patients with a prior failed catheter ablation had fewer risk factors for AF recurrence but more frequently had AF recurrence after thoracoscopic AF ablation than ablation naïve patients. This may in part be explained by more progressed, subclinical, atrial fibrosis formation.

Original languageEnglish
JournalRevista Española de Cardiología (English version)
Publication statusE-pub ahead of print - 22 Sep 2022

Bibliographical note

Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.


  • Atrial fibrillation
  • Catheter ablation
  • Propensity score
  • Thoracoscopic surgical ablation

Cite this