Predictors of long-term outcome in patients undergoing a first repeat ablation consisting solely of re-isolation of reconnected pulmonary veins

Juan-Pablo Abugattas, Bruno Schwagten, Jeroen De Cocker, Hugo-Enrique Coutiño, Francesca Salghetti, Varnavas Varnavas, Erwin Ströker, Juan Sieira, Michael Wolf, Pedro Brugada, Carlo de Asmundis, Gian-Battista Chierchia, Yves De Greef

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Abstract

Aim: To define predictors of long-term outcome of a first repeat ablation solely consisting of re-isolation of reconnected pulmonary veins (PVs). Methods: Three hundred seven patients (age 59 ± 9%, 77% males, non-paroxysmal AF 43%) with recurrent AF after first PVI were studied. Re-isolation of reconnected PVs was guided by a circular mapping catheter and 3D mapping system using RF ablations. A PV was defined as "triggering" in case of spontaneous ectopy or AF paroxysms originating from the PV. Results: After a mean follow-up of 5.05 ± 2.21 years, 194 (63.2%) patients (73.0% in PAF vs 50.4% in non-PAF, log Rank <0.001) were free from AF. A "triggering" PV was present in 48 (15.6%) during the first PVI and in 52 (16.9%) at repeat. Independent predictors of recurrence were a non-PAF type (HR: 1.814, 95%CI: 1.090 - 3.018, p=0.022) and early recurrence (= 3 months) after first PVI (HR: 1.632, 95%CI: 1.091 - 2.443, p=0.017) while a "triggering" PV at first or repeat was a predictor of good outcome (HR: 0.574; 95%CI: 0.344 - 0.959; p=0.034) in the multivariable analysis. Conclusions: A repeat ablation solely consisting of re-isolation of reconnected PVs results in a high degree of long-term AF freedom, especially in PAF and in case of a PV trigger at index or repeat. Patients with non-PAF or experiencing early AF recurrence after first PVI are less responsive.

Original languageEnglish
Article number2114
Number of pages9
JournalJournal of Atrial Fibrillation
Volume11
Issue number5
DOIs
Publication statusPublished - Feb 2019

Keywords

  • Ablation
  • atrial fibrillation
  • re-isolation
  • repeat
  • triggering PV

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