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Atrial fibrillation patients with isolated pulmonary veins: Is sinus rhythm achievable?
Author(s) -
Szilágyi Judit,
Marcus Gregory M.,
Badhwar Nitish,
Lee Byron K.,
Lee Randall J.,
Vedantham Vasanth,
Tseng Zian H.,
Walters Tomos,
Scheinman Melvin,
Olgin Jeffrey,
Gerstenfeld Edward P.
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13230
Subject(s) - medicine , atrial fibrillation , ablation , cardiology , sinus rhythm , pulmonary vein , catheter ablation
Background The cornerstone of atrial fibrillation (AF) ablation is isolation of the pulmonary veins (PVs). Patients with recurrent AF undergoing repeat ablation usually have PV reconnection (PVr). The ablation strategy and outcome of patients undergoing repeat ablation who have persistent isolation of all PVs (PVi) at the time of repeat ablation is unknown. Methods and results We studied consecutive patients with recurrent AF undergoing repeat ablation and compared patients with PVi to those with PVr. One hundred fifty‐two patients underwent repeat ablation, and of these, 25 patients (16.4%) had PVi. Patients with PVi underwent ablation targeting any isoproterenol induced AF triggers, atrial substrate, or inducible atrial tachycardias or flutters. Patients with PVi compared to PVr were more likely to have a history of persistent AF (64% vs. 26%; P < 0.0001), obesity (BMI 30.4 vs. 28.2; P = 0.05), and prior use of contact force sensing catheters (28% vs. 0.8%, P < 0.0001). After a mean follow‐up of 19 ± 15 months, 56% of PVi patients remained in sinus rhythm compared to 76.3% of PVr patients (P = 0.036). In a multivariable model, PVi patients and those with cardiomyopathy had a higher risk of recurrent atrial tachyarrhythmias (HR = 3.6 95%, CI 1.6–8.3, P = 0.002 and HR = 6.2, 95% CI 2.3–16.3, P < 0.0001, respectively). Conclusion In patients who have all PVs isolated at the time of the redo AF ablation, a strategy of targeting non‐PV AF triggers and inducible flutters can still lead to AF freedom in more than half of patients. Patients with PVr, however, have a better long‐term outcome.