Less Pulmonary Vein Reconnection at Redo Procedures Following Radiofrequency Point-by-Point Antral Pulmonary Vein Isolation With the Use of Contemporary Catheter Ablation Technologies

Abstract

OBJECTIVES: This study investigated whether real-world use of contemporary technologies changed pulmonary vein (PV) reconnection and redo pulmonary vein isolation (PVI) procedure frequencies.

BACKGROUNDS: Previous studies consistently reported that following PVI recurrence of PV conduction is observed in >80% of patients.

METHODS: Consecutive patients undergoing 529 first and/or redo radiofrequency point-by-point PVI between January 2013 and December 2016 were included.

Results: Between 2013 and 2016, redo PVI rate in atrial fibrillation significantly decreased (p < 0.001); in ≤12 months, first redo PVI rate decreased from 19% to 4%. The percentage of patients having PV reconnection at second PVI significantly decreased from 90% to 29% (p = 0.001). One PVI was performed in 393 and >1 in 79 patients. Female sex was associated with >1 PVI (hazard ratio [HR]: 1.86; 95% confidence interval [CI]: 1.10 to 3.13, p = 0.02). Sixty patients underwent first and second PVI in the study period. Female sex (HR: 2.79; 95% CI: 1.67 to 4.64; p < 0.001) and left atrial diameter (HR: 1.05; 95% CI: 1.01 to 1.08; p = 0.01) were associated with more and use of automatic ablation annotation algorithm during first PVI with fewer (HR: 0.54; 95% CI: 0.32 to 0.92; p = 0.02) redo PVI procedures. In 31 of 60 patients, ≥1 PV was reconnected at second PVI. The need for “touch-up” applications at the first PVI was the only predictor of PV reconnection.

CONCLUSION: Redo rate in atrial fibrillation and PV reconnection at redo PVI significantly decreased in recent years. Male sex, left atrial diameter, and use of automatic ablation annotation algorithm at first PVI were associated with fewer redo procedures. First-pass isolation was associated with lower PV reconnection rate at second procedure. Female sex was associated with more redo procedures but not higher PV reconnection frequencies.

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Citation
JACC: Clinical Electrophysiology Available online 28 November 2018