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Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence
Study Questions:
How well does pulmonary vein reconnection (PVR) correlate with recurrent atrial fibrillation (AF) following pulmonary vein isolation (PVI)?
Methods:
Eleven studies (10 observational, 1 randomized) that evaluated the status of the pulmonary veins in patients with and without recurrent AF after PVI were included in this review/meta-analysis. There were a total of 683 patients with and 304 without recurrent AF. Electrophysiologic testing was repeated a mean of 5.5 months post-ablation in patients with recurrent AF and a mean of 7.9 months post-ablation in patients without recurrent AF.
Results:
PVR was found in 85.5% of patients with recurrent AF and in 58.6% of patients without recurrent AF. Durable PVI was associated with a 43% lower risk of recurrent AF. The number of reconnected pulmonary veins (PVs) did not correlate with the risk of recurrent AF.
Conclusions:
PVR is common in patients with recurrent AF post-PVI, but also is present in >50% of patients without recurrent AF.
Perspective:
The results suggest that persistent PVI may not be required to prevent recurrent AF among patients who have undergone catheter ablation to isolate the PVs. It is possible that some of the reconnected PVs were not sources of AF triggers. The absence of recurrent AF despite PVR also might be explained by a persistent autonomic effect of the first ablation procedure or by permanent ablation of antral drivers outside the PV ostia. However, some patients who have undergone PVI do not have recurrent AF until after the first year of follow-up. It is possible that patients with PVR are destined to have recurrent AF during long-term follow-up.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Electrophysiology, Pulmonary Veins, Risk, Secondary Prevention
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