Arrhythmia Type After Persistent Atrial Fibrillation Ablation Predicts Success of the Repeat Procedure
What is the prognostic significance of recurrent atrial fibrillation (AF) versus atrial tachycardia (AT) after an initial radiofrequency catheter ablation (RFCA) procedure for persistent AF?
Seventy-eight patients (mean age 61 years) underwent a second ablation procedure >3 months after undergoing RFCA of persistent AF. The initial ablation strategy was circumferential pulmonary vein isolation plus linear ablation or ablation of complex fractionated atrial electrograms. The second ablation procedure was performed for persistent AT in 36 patients (group 1), persistent AF in 37 patients (group 2), and paroxysmal AF in five patients (group 3). Efficacy was assessed with serial 7-day Holter monitors. The primary endpoint was freedom from AF/AT lasting >30 seconds off antiarrhythmic drug therapy.
The proportion of patients reaching the primary endpoint at 9 months was significantly higher in group 1 (59%) than in group 2 (28%), and was highest in group 3 (100%). After a third ablation procedure in 28% and 32% of patients in groups 1 and 2, respectively, the primary endpoint was reached at 9 months of follow-up significantly more often in group 1 (71%) than in group 2 (38%).
When additional ablation is necessary after RFCA of persistent AF, midterm efficacy is higher when the recurrent arrhythmia is persistent AT than when it is persistent AF.
The specific techniques used to ablate persistent AF are highly variable between different electrophysiology laboratories. Therefore, the results of this study may not apply to many other high-volume ablation centers. For example, a success rate of only 38% after three RFCA procedures directed at persistent AF is uncharacteristically low compared to other published results.
Keywords: Tachycardia, Supraventricular, Pulmonary Veins, Atrial Fibrillation, Catheter Ablation, Pregnancy, Atrial Flutter
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