Natural history of arrhythmia after successful isolation of pulmonary veins, left atrial posterior wall, and superior vena cava in patients with paroxysmal atrial fibrillation: A multi-center experience

Sanghamitra Mohanty, Chintan Trivedi, Pamela Horton, Domenico G.Della Rocca, Carola Gianni, Bryan Macdonald, Angel Mayedo, Javier Sanchez, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney P. Horton, J. David Burkhardt, Antonio Dello Russo, Michela Casella, Claudio Tondo, Sakis Themistoclakis, Giovanni Forleo, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: We evaluated long-term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities. METHODS AND RESULTS: A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia-free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidi-ties); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10 years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3–8.5) and 5.6 (IQI 3.8–8.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147/201 and 414/456 received left atrial appendage and coronary sinus isolation and 54/201 and 42/456 had left atrial lines and flutter ablation. At 2 years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage/coronary sinus isolation remained arrhythmia-free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation (P<0.001). CONCLUSIONS: Very late recurrence of atrial fibrillation after successful isolation of pulmonary veins, regardless of the comorbid-ity profile, was majorly driven by non-pulmonary vein triggers and ablation of these foci resulted in high success rate. However, presence of comorbidities was associated with significantly earlier recurrence.

Original languageEnglish (US)
Article numbere020563
JournalJournal of the American Heart Association
Volume10
Issue number11
DOIs
StatePublished - 2021

Keywords

  • catheter ablation
  • Late recurrence
  • Left atrial appendage
  • Paroxysmal atrial fibrillation
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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