Very Late Relapse of Atrial Fibrillation after Pulmonary Vein Isolation: Incidence and Results of Repeat Ablation

Background:  There are few data about the incidence of very late (>12 months) arrhythmia relapse after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and about the success rate of repeat ablation procedures in this population. Methods:  All patients treated with PVI for pa...

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Published in:Pacing and clinical electrophysiology 2010-10, Vol.33 (10), p.1258-1263
Main Authors: FICHTNER, STEPHANIE, CZUDNOCHOWSKY, ULRICH, HESSLING, GABRIELE, REENTS, TILKO, ESTNER, HEIDI, WU, JINJIN, JILEK, CLEMENS, AMMAR, SONIA, KARCH, MARTIN R., DEISENHOFER, ISABEL
Format: Article
Language:English
Subjects:
Adult
atrial fibrillation
Atrial Fibrillation - epidemiology
Atrial Fibrillation - surgery
Biological and medical sciences
Cardiac dysrhythmias
Cardiology. Vascular system
Catheter Ablation - statistics & numerical data
CFAE
Chronic Disease
Cohort Studies
Electrocardiography, Ambulatory
Female
Follow-Up Studies
Heart
Heart Atria - surgery
Humans
Incidence
late
Male
Medical sciences
Middle Aged
paroxysmal
pulmonary vein isolation
Pulmonary Veins - surgery
Recurrence
relapse
Treatment Outcome
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Summary:Background:  There are few data about the incidence of very late (>12 months) arrhythmia relapse after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and about the success rate of repeat ablation procedures in this population. Methods:  All patients treated with PVI for paroxysmal AF were screened in the institution's electrophysiology database. Follow‐up data at 1, 3, 6, and 12 months and yearly thereafter including repetitive (7 days or 1 day) Holter electrocardiograms were assessed as well as the technique and success rate of repeat ablations. Results:  Overall, 24 of 356 (6.7%) patients experienced their first AF recurrence more than 12 months after PVI. Of these 24 patients, 14 underwent reablation for paroxysmal (11 patients) or persistent AF (three patients). Repeat ablation included re‐PVI in all 14 patients (43 of 48 initially isolated PVs with recovered left atrial–PV conduction). Ablation of complex fractionated atrial electrograms or left/right atrial lines was performed in eight patients, including the three patients with persistent AF. During follow‐up of 15.1 ± 9 months after the second ablation, 10 of 14 (71%) reablated patients remained in sinus rhythm. Conclusions : After PVI for paroxysmal AF, very late arrhythmia recurrence occurs in less than 10% of patients. The success rate of the repeat procedure is high. (PACE 2010; 33:1258–1263)
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.2010.02808.x