Background: Pulmonary vein electrical isolation (PVI) is an effective treatment for atrial fibrillation (AF). However, recurrence of pulmonary vein (PV) conduction after ablation may limit long-term success. Early identification and treatment of acute PV conduction recovery during initial ablation may have an impact on subsequent clinical results.
Objective: to assess the prevalence of acute PV conduction recovery during the observation time after PV isolation for paroxysmal AF, and to evaluate the impact of re-isolation treatment on long-term clinical results.
Methods: 76 patients with paroxysmal AF were randomized to 2 groups to undergo PVI. Patients were randomly assigned to 2 groups. Group A (Study Group: 38 patients): 30 minutes of observation were given following PV isolation for detection of acute PV-reconnection, with re-ablation of reconnected PVs. Group B (Control Group: 38 patients). Ablation procedure was done either by conventional method or using 3D electro-anatomical mapping. Symptoms, ECG and Holter monitoring were used to evaluate the clinical effectiveness of ablation. Any episode of symptomatic or asymptomatic atrial tachyarrhythmia that lasted more than 30 seconds documented with ECG or Holter monitoring was considered a recurrence.
Results: There was no statistically significant difference in age, sex, AF history, previous AF ablation, structural heart diseases & antiarrhythmic drug history among both groups. In the study group, 14 patients (36.8%) showed no PV reconnection, while 24 patients (63.2%) showed acute PV reconnection within 30 minutes. The LSPV showed the highest rate of acute PV reconnection during the observation period (66.6% of patients showing PV reconnection). AF recurred in only 6 patients (15.8%) in the study group in comparison to 20 patients (52.6%) having AF recurrence post-ablation in the control group. Among 24 patients of the study group, who showed PV reconnection which was re-isolated, only 4 patients (16.7%) had AF recurrence on follow up. In patients who did not show PV reconnection (14 patients), only 2 patients (14.3%) had AF recurrence on follow up.
Conclusion: Re-isolation of recovered PV conduction contributed to the improvement in the success rate of ablation for paroxysmal AF.
Credits: Saeed Khaled¹ , Samir Wafa¹ , Hayam Eldamanhoury¹ , Ahmed Nabil¹