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Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations
Author(s) -
Mohanty Sanghamitra,
Trivedi Chintan,
Gianni Carola,
Della Rocca Domenico Giovanni,
Morris Eli Hamilton,
Burkhardt J. David,
Sanchez Javier E.,
Horton Rodney,
Gallinghouse G. Joseph,
Hongo Richard,
Beheiry Salwa,
AlAhmad Amin,
Di Biase Luigi,
Natale Andrea
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.13329
Subject(s) - medicine , ablation , atrial fibrillation , catheter ablation , cardiology , sinus rhythm , coronary sinus , surgery
This study reports the procedural findings and ablation outcome in AF patients referred after ≥2 failed PV isolation (PVI). Methods Three hundred and five consecutive AF patients referred after ≥2 PVI were included in the analysis. High‐dose isoproterenol challenge was used to identify PV reconnection and non‐PV triggers; the latter were ablated based on the operator's discretion during the index procedure. At the repeat procedure, non‐PV triggers were ablated in all. Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non‐PV triggers were detected. Results PV reconnection was detected in 226 and non‐PV triggers were identified or empirically isolated in 285 patients during the index procedure. At follow‐up, 182 (60%) patients were recurrence‐free off‐AAD; the success rate with and without non‐PV ablation was 81% vs. 8% (P < 0.0001). 104 patients underwent repeat procedure with non‐PV trigger ablation in all. At 1 year, 90% were arrhythmia free off‐AAD in non‐PV ablation group, and 72% who did not receive non‐PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5% and 82% after the index and repeat procedure, respectively. Conclusion In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non‐PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non‐PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia‐free survival.