TY - JOUR
T1 - Natural history of arrhythmia after successful isolation of pulmonary veins, left atrial posterior wall, and superior vena cava in patients with paroxysmal atrial fibrillation
T2 - A multi-center experience
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Horton, Pamela
AU - Rocca, Domenico G.Della
AU - Gianni, Carola
AU - Macdonald, Bryan
AU - Mayedo, Angel
AU - Sanchez, Javier
AU - Gallinghouse, G. Joseph
AU - Al-Ahmad, Amin
AU - Horton, Rodney P.
AU - Burkhardt, J. David
AU - Russo, Antonio Dello
AU - Casella, Michela
AU - Tondo, Claudio
AU - Themistoclakis, Sakis
AU - Forleo, Giovanni
AU - Di Biase, Luigi
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2021 The Authors.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: We evaluated long-term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities. METHODS AND RESULTS: A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia-free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidi-ties); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10 years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3–8.5) and 5.6 (IQI 3.8–8.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147/201 and 414/456 received left atrial appendage and coronary sinus isolation and 54/201 and 42/456 had left atrial lines and flutter ablation. At 2 years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage/coronary sinus isolation remained arrhythmia-free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation (P<0.001). CONCLUSIONS: Very late recurrence of atrial fibrillation after successful isolation of pulmonary veins, regardless of the comorbid-ity profile, was majorly driven by non-pulmonary vein triggers and ablation of these foci resulted in high success rate. However, presence of comorbidities was associated with significantly earlier recurrence.
AB - BACKGROUND: We evaluated long-term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities. METHODS AND RESULTS: A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia-free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidi-ties); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10 years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3–8.5) and 5.6 (IQI 3.8–8.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147/201 and 414/456 received left atrial appendage and coronary sinus isolation and 54/201 and 42/456 had left atrial lines and flutter ablation. At 2 years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage/coronary sinus isolation remained arrhythmia-free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation (P<0.001). CONCLUSIONS: Very late recurrence of atrial fibrillation after successful isolation of pulmonary veins, regardless of the comorbid-ity profile, was majorly driven by non-pulmonary vein triggers and ablation of these foci resulted in high success rate. However, presence of comorbidities was associated with significantly earlier recurrence.
KW - Late recurrence
KW - Left atrial appendage
KW - Paroxysmal atrial fibrillation
KW - Pulmonary vein isolation
KW - catheter ablation
UR - http://www.scopus.com/inward/record.url?scp=85107390780&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85107390780&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.020563
DO - 10.1161/JAHA.120.020563
M3 - Article
C2 - 33998277
AN - SCOPUS:85107390780
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e020563
ER -