Predictors of Recurrence After a Repeat Ablation Procedure for Paroxysmal Atrial Fibrillation

Role of Left Atrial Enlargement

Ri-Bo Tang; Xian-Liang Yan; Jian-Zeng Dong; Jerome Kalifa; De-Yong Long; Rong-Hui Yu; Rong Bai; Jun-Ping Kang; Jia-Hui Wu; Cai-Hua Sang; Man Ning; Chen-Xi Jiang; Mohamed Salim; Chang-Sheng Ma

Disclosures

Europace. 2014;16(11):1569-1574. 

In This Article

Abstract and Introduction

Abstract

Aims This study sought to explore the predictors of recurrence in patients with paroxysmal atrial fibrillation (AF) undergoing repeat catheter ablation, especially the impact of left atrial (LA) remodelling after the original procedure on the outcome of repeat procedure.

Methods and results Ninety-five patients undergoing repeat ablation were enroled in this study. Repeat procedure endpoints were pulmonary vein isolation, linear block when linear ablation is performed, and non-inducibility of atrial tachyarrhythmia by burst pacing. Patients with LA enlargement between the pre-original procedure and pre-repeat procedure were categorized as Group 1 (35 patients), while individuals with no change or decrease of LA diameter were categorized as Group 2 (60 patients). The mean duration from the original procedure to the repeat procedure was 12 months (1–40 months). After 29.6 ± 20.5 (3–73) months follow-up from the repeat procedure, 33 patients experienced recurrence (34.7%). The recurrence rate was significantly higher in Group 1 than in Group 2 (51.4 VS. 25.0%, P = 0.017). In univariate analysis, LA remodelling was the only predictor of recurrence. In multivariate analysis, after adjustment for age and LA diameter, Group 1 had a greater risk of recurrence after the repeat procedure (hazard ratio = 2.22, 95% confidence interval: 1.02–4.81, P = 0.043).

Conclusions Left atrial enlargement after undergoing the original catheter ablation of paroxysmal AF was an independent risk factor of recurrence after repeat ablation.

Introduction

Pulmonary vein isolation (PVI) has become the mainstream therapy for patients with drug-refractory paroxysmal atrial fibrillation (AF), since PV foci were discovered as the trigger for AF.[1] The efficacy and safety of catheter ablation of paroxysmal AF have been reported by several randomized studies.[2–5] Moreover, there are many studies which have explored the predictors of recurrence after the index AF ablation.[6–9] However, studies focusing on the predictors of recurrence after the repeat procedure are limited.[10,11] Atrial structural remodelling can be observed in patients who underwent AF ablation, which might possibly affect the outcome of the procedure.[7,9,12] In this study, we aimed to find the predictors of the outcome of repeat procedure of catheter ablation of paroxysmal AF, and especially to explore the impact of left atrial (LA) remodelling on the outcome of repeat procedure after the original catheter ablation of paroxysmal AF.

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