Ablation technique may not affect AF recurrence after redo ablation with durable PVI
Click Here to Manage Email Alerts
Radiofrequency ablation technique was not associated with any difference in atrial fibrillation recurrence after redo ablation despite durable initial pulmonary vein isolation, researchers reported.
“Recurrences of AF after an initial ablation are mainly due to pulmonary vein reconnection,” Karim Benali, MD, electrophysiologist at Rennes University Hospital in France, and colleagues wrote. “However, the absence of pulmonary vein reconnection (durable pulmonary vein isolation) is observed in up to 60% of patients undergoing redo ablation of AF in recent studies. The optimal ablative strategy for these patients remains unknown, leading to a wide diversity of operator-dependent approaches.”
Image: Adobe Stock
PARTY-PVI is an observational, retrospective study performed at 39 centers that enrolled 367 patients who were referred for redo AF ablation despite durable pulmonary vein isolation (PVI) between 2010 and 2020 (mean age, 63 years; 67% men; mean CHA2DS2-VASc score, 1.7; mean BMI, 28 kg/m2). Overall, 71.7% of participants had left atrial dilation.
Initial PVI was performed using radiofrequency ablation in 48% of patients and cryoballoon ablation in 52%.
For their redo procedures, 60% of patients underwent linear-based ablation, 45% underwent electrogram-based ablation, 27% underwent trigger-based ablation and 15% underwent pulmonary vein-based ablation.
The results of the PARTY-PVI were published in Circulation: Arrhythmia and Electrophysiology.
During an average follow-up of 22 months, 33% of patients had a recurrence of atrial arrhythmia at 12 months and 43% patients had recurrence at 24 months.
Benali and colleagues observed no significant difference in arrhythmia-free survival between the four different ablation strategies.
Left atrial dilatation was the only factor associated with arrhythmia-free survival after redo ablation (HR = 1.59; 95% CI, 1.13-2.23; P = .006), according to the study.
“In the specific population of patients with recurrent AF despite durable PVI, the different ablative strategies did not impact midterm survival free from atrial arrhythmias,” the researchers wrote. “A growing number of studies have described AF as a consequence of an underlying atrial myopathy whose progression is linked to different elements, as obesity, hypertension, sleep apnea, diabetes, or alcohol. Therefore, ablating the underlying substrate without treating these factors of AF progression may lead to AF recurrences, regardless of the ablation strategy. Conversely, a better management of these factors seems to promote reverse atrial remodeling and is associated with better arrhythmia control, even in the absence of ablation.”
Collapse
Click Here to Manage Email Alerts