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Predictors of Long-Term outcome in Patients Undergoing a First Repeat Ablation Consisting Solely of Re-isolation of Reconnected Pulmonary Veins

Aims: To define predictors of long-term outcome of a first repeat ablation solely consisting of re-isolation of reconnected pulmonary veins (PVs). Methods: Three hundred seven patients (age 59 ± 9%, 77% males, non-paroxysmal AF 43%) with recurrent AF after first PVI were studied. Re-isolation of reconnected PVs was guided by a circular mapping catheter and 3D mapping system using RF ablations. A PV was defined as “triggering” in case of spontaneous ectopy or AF paroxysms originating from the PV. Results: After a mean follow-up of 5.05 ± 2.21 years, 194 (63.2%) patients (73.0% in PAF vs 50.4% in non-PAF, log Rank <0.001) were free from AF. A “triggering” PV was present in 48 (15.6%) during the first PVI and in 52 (16.9%) at repeat. Independent predictors of recurrence were a non-PAF type (HR: 1.814, 95%CI: 1.090 - 3.018, p=0.022) and early recurrence (≤ 3 months) after first PVI (HR: 1.632, 95%CI: 1.091 - 2.443, p=0.017) while a “triggering” PV at first or repeat was a predictor of good outcome (HR: 0.574; 95%CI: 0.344 - 0.959; p=0.034) in the multivariable analysis. Conclusions: A repeat ablation solely consisting of re-isolation of reconnected PVs results in a high degree of long-term AF freedom, especially in PAF and in case of a PV trigger at index or repeat. Patients with non-PAF or experiencing early AF recurrence after first PVI are less responsive.

Credits: Juan-Pablo Abugattas MD1,2; Bruno Schwagten MD, PhD1; Jeroen De Cocker MD1; Hugo-Enrique Coutio, MD2; Francesca Salghetti, MD2; Varnavas Varnavas, MD, PhD2; Erwin Strker MD2; Juan Sieira MD, PhD2; Michael Wolf MD1; Pedro Brugada MD, PhD2; Carlo de Asmundis MD PhD2; Gian-Battista Chierchia MD, PhD2; Yves De Greef, MD, PhD1,2.

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