{"@context":"https://schema.org","@type":"ScholarlyArticle","headline":"P2849Prevalence and significance of sustained pulmonary vein isolation in repeat AF ablation procedures","author":[{"@type":"Person","name":"D. Matos"},{"@type":"Person","name":"D. Cavaco"},{"@type":"Person","name":"G. Rodrigues"},{"@type":"Person","name":"J. Carmo"},{"@type":"Person","name":"M. Carvalho"},{"@type":"Person","name":"A. Ferreira"},{"@type":"Person","name":"F. Costa"},{"@type":"Person","name":"P. Carmo"},{"@type":"Person","name":"F. Morgado"},{"@type":"Person","name":"M. Mendes"},{"@type":"Person","name":"P. Adragao"}],"datePublished":"2019","isPartOf":{"@type":"Periodical","name":"European Heart Journal"},"identifier":"https://doi.org/10.1093/eurheartj/ehz748.1158","description":"Abstract\n \n Introduction\n Pulmonary vein (PV) reconnection is a common cause of relapse after catheter ablation of atrial fibrillation (AF). However, some patients have AF recurrence despite durable PV isolation. The aim of this study was to assess the PV isolation status at the time of a second catheter ablation (redo) procedure, and its relationship with subsequent AF relapse.\n \n \n Methods\n Consecutive patients with symptomatic drug-resistant AF who underwent redo procedures from January 2006 to December 2017 were identified in a single-center observational registry. Pulmonary vein isolation status was assessed during the electrophysiologic study with a circular mapping catheter. Additional radiofrequency (RF) energy applications were also recorded. AF relapse was defined as symptomatic or documented AF/atrial tachycardia/atrial flutter after a 3-month blanking period.\n \n \n Results\n We identified 240 patients (77 [32%] females, median age 61 [IQR 53–67] years, 85 [35%] with non-paroxysmal AF) undergoing redo procedures during the study period. At the time of redo, 17 (7%) of the patients presented bidirectional conduction block of all PVs. PV reconnection occurred in 157 (65%) of cases in the left superior vein, 142 (59%) in the left inferior vein, 177 (73%) in the right superior vein, and 163 (68%) in the right inferior vein (table). All of the PVs were reconducted in 91 (38%) patients. Additional RF applications were performed in the left atrium (LA) roof, LA posterior wall, cavotricuspid isthmus, mitral isthmus, superior vena cava, coronary sinus, and left atrial appendage ostium, at the operator's discretion (table 1).\n Over a median follow-up of 2-years (IQR 1–5), 126 patients (53%) suffered AF recurrence, yielding a mean relapse rate of 17%/year. In multivariate Cox regression analysis, the lack of PV reconnection at the time of redo emerged as an independent predictor of subsequent relapse (HR 1.97, 95% CI 1.12–3.49, p=0.019) even after adjustment for univariate predictors including non-paroxysmal AF, body mass index, female sex, and active smoking.\n \n \n \n Conclusion\n In patients undergoing redo AF ablation procedures, less than 10% present with complete PV isolation. Despite being relatively infrequent, this finding is independently associated with greater likelihood of subsequent recurrence, suggesting that other mechanisms, not fully addressed by additional RF applications, are at play.\n ","url":"https://innscience.ca/es/community/literature/8ef73df8-36b8-4b42-983b-3fc7d9f83527"}