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Repeat catheter ablation associated with freedom from AF in patients where first procedure failed to contain AF
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Patients with atrial fibrillation whose arrhythmias continue after a first catheter ablation procedure may benefit from repeat ablation, especially patients with paroxysmal atrial fibrillation.
Researchers enrolled 1,404 consecutive patients undergoing catheter ablation for AF. Patients were divided into either a paroxysmal AF group (n=728), a persistent AF group (n=293) or a long-standing persistent AF group (n=383). Among the 1,404 patients included in the overall population, 676 (48.1%) had nonparoxysmal AF. All patients underwent antral isolation of all four pulmonary veins and the superior vena cava. Mean follow-up was 57 months.
Among the total study population, 385 (27.3%) patients had recurrence after the primary ablation procedure, which resulted in freedom from AF in 1,019 (72.6%) of the patients. At follow-up, 565 patients in the paroxysmal AF group and 454 patients in the nonparoxysmal AF group (77.6% vs. 67.2%; P<.001) had freedom from AF following a single ablation procedure. In patients with recurrences of arrhythmia, 74.2% (121 of 163) in the paroxysmal group and 74.8% (166 of 222) in the nonparoxysmal group underwent repeat ablation; 92.4% of those patients with paroxysmal AF and 84.0% of those patients with nonparoxysmal AF continued to be free from AF.
“The results show that isolation of the pulmonary vein antrum and the superior vena cava using intracardiac echocardiography and circular mapping can achieve encouraging cure rates in both patients with paroxysmal AF and those with nonparoxysmal AF, even when the procedure is performed at different centers by different operators,” the researchers concluded. “Although the success rate is higher in patients with paroxysmal AF, repeat catheter ablation is a useful strategy to enhance freedom from AF and should be taken into consideration when planning ablation in patients with AF.”
Bhargava M. Heart Rhythm. 2009;6:1403-1412.