Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation

David Lin, Pasquale Santangeli, Erica S. Zado, Rupa Bala, Mathew D. Hutchinson, Michael P. Riley, David S. Frankel, Fermin Garcia, Sanjay Dixit, David J. Callans, Francis E. Marchlinski

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Introduction Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized. Methods and Results All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6%) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41%) had 4 reconnected PVs, 27 (16%) had 3, 31 (18%) had 2, and 29 (17%) had 1. Only 13 (8%) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50%), and reproducible PV APDs in 28 (22%). Thirty-six (20%) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47%) had no AF off antiarrhythmic drugs (AAD); 28 (21%) had no AF with AAD; and 18 (13%) had rare AF with good symptom control; 26 patients (19%) had recurrent AF. Conclusions At time of third or greater AF ablation, PV reconnection is the rule (92%) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81% of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.

Original languageEnglish (US)
Pages (from-to)371-377
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume26
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

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Catheter Ablation
Atrial Fibrillation
Pulmonary Veins
Veins
pamidronate
Anti-Arrhythmia Agents
Cardiac Arrhythmias
Tachycardia
Recurrence

Keywords

  • atrial fibrillation
  • catheter ablation
  • pulmonary vein isolation
  • reconnection
  • repeat ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation. / Lin, David; Santangeli, Pasquale; Zado, Erica S.; Bala, Rupa; Hutchinson, Mathew D.; Riley, Michael P.; Frankel, David S.; Garcia, Fermin; Dixit, Sanjay; Callans, David J.; Marchlinski, Francis E.

In: Journal of Cardiovascular Electrophysiology, Vol. 26, No. 4, 01.04.2015, p. 371-377.

Research output: Contribution to journalArticle

Lin, D, Santangeli, P, Zado, ES, Bala, R, Hutchinson, MD, Riley, MP, Frankel, DS, Garcia, F, Dixit, S, Callans, DJ & Marchlinski, FE 2015, 'Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation', Journal of Cardiovascular Electrophysiology, vol. 26, no. 4, pp. 371-377. https://doi.org/10.1111/jce.12603
Lin, David ; Santangeli, Pasquale ; Zado, Erica S. ; Bala, Rupa ; Hutchinson, Mathew D. ; Riley, Michael P. ; Frankel, David S. ; Garcia, Fermin ; Dixit, Sanjay ; Callans, David J. ; Marchlinski, Francis E. / Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2015 ; Vol. 26, No. 4. pp. 371-377.
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abstract = "Introduction Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized. Methods and Results All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6{\%}) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41{\%}) had 4 reconnected PVs, 27 (16{\%}) had 3, 31 (18{\%}) had 2, and 29 (17{\%}) had 1. Only 13 (8{\%}) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50{\%}), and reproducible PV APDs in 28 (22{\%}). Thirty-six (20{\%}) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47{\%}) had no AF off antiarrhythmic drugs (AAD); 28 (21{\%}) had no AF with AAD; and 18 (13{\%}) had rare AF with good symptom control; 26 patients (19{\%}) had recurrent AF. Conclusions At time of third or greater AF ablation, PV reconnection is the rule (92{\%}) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81{\%} of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.",
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T1 - Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation

AU - Lin, David

AU - Santangeli, Pasquale

AU - Zado, Erica S.

AU - Bala, Rupa

AU - Hutchinson, Mathew D.

AU - Riley, Michael P.

AU - Frankel, David S.

AU - Garcia, Fermin

AU - Dixit, Sanjay

AU - Callans, David J.

AU - Marchlinski, Francis E.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Introduction Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized. Methods and Results All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6%) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41%) had 4 reconnected PVs, 27 (16%) had 3, 31 (18%) had 2, and 29 (17%) had 1. Only 13 (8%) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50%), and reproducible PV APDs in 28 (22%). Thirty-six (20%) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47%) had no AF off antiarrhythmic drugs (AAD); 28 (21%) had no AF with AAD; and 18 (13%) had rare AF with good symptom control; 26 patients (19%) had recurrent AF. Conclusions At time of third or greater AF ablation, PV reconnection is the rule (92%) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81% of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.

AB - Introduction Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized. Methods and Results All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6%) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41%) had 4 reconnected PVs, 27 (16%) had 3, 31 (18%) had 2, and 29 (17%) had 1. Only 13 (8%) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50%), and reproducible PV APDs in 28 (22%). Thirty-six (20%) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47%) had no AF off antiarrhythmic drugs (AAD); 28 (21%) had no AF with AAD; and 18 (13%) had rare AF with good symptom control; 26 patients (19%) had recurrent AF. Conclusions At time of third or greater AF ablation, PV reconnection is the rule (92%) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81% of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.

KW - atrial fibrillation

KW - catheter ablation

KW - pulmonary vein isolation

KW - reconnection

KW - repeat ablation

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