Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations.

Abstract

INTRODUCTION:

This study reports the procedural findings and ablation outcome in AF patients referred after ≥2 failed PV isolation (PVI).

METHODS:

Three hundred and five consecutive AF patients referred after ≥2 PVI were included in the analysis. High-dose isoproterenol challenge was used to identify PV reconnection and non-PV triggers; the latter were ablated based on the operator's discretion during the index procedure. At the repeat procedure, non-PV triggers were ablated in all. Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non-PV triggers were detected.

RESULTS:

PV reconnection was detected in 226 and non-PV triggers were identified or empirically isolated in 285 patients during the index procedure. At follow-up, 182 (60%) patients were recurrence-free off-AAD; the success rate with and without non-PV ablation was 81% vs. 8% (P < 0.0001). 104 patients underwent repeat procedure with non-PV trigger ablation in all. At 1 year, 90% were arrhythmia free off-AAD in non-PV ablation group, and 72% who did not receive non-PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5% and 82% after the index and repeat procedure, respectively.

CONCLUSION:

In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non-PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non-PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia-free survival.

• Authors: Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Domenico Giovanni Della Rocca, Eli Hamilton Morris, J David Burkhardt, Javier E Sanchez, Rodney Horton, G Joseph Gallinghouse, Richard Hongo, Salwa Beheiry, Amin Al-Ahmad, Luigi Di Biase, Andrea Natale
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 28 Issue 12 Pg. 1379-1386 (Dec 2017) ISSN: 1540-8167 [Electronic] United States
• PMID: 28841251 (Publication Type: Journal Article)
• Copyright: © 2017 Wiley Periodicals, Inc.

Topics

• Aged
• Atrial Fibrillation (diagnosis, physiopathology, surgery)
• Catheter Ablation (methods, trends)
• Electrocardiography (trends)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Recurrence
• Referral and Consultation (trends)
• Registries
• Risk Factors
• Treatment Failure
• Treatment Outcome