Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations

Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Domenico Giovanni Della Rocca, Eli Hamilton Morris, J. David Burkhardt, Javier E. Sanchez, Rodney Horton, G. Joseph Gallinghouse, Richard Hongo, Salwa Beheiry, Amin Al-Ahmad, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: This study reports the procedural findings and ablation outcome in AF patients referred after ≥2 failed PV isolation (PVI). Methods: Three hundred and five consecutive AF patients referred after ≥2 PVI were included in the analysis. High-dose isoproterenol challenge was used to identify PV reconnection and non-PV triggers; the latter were ablated based on the operator's discretion during the index procedure. At the repeat procedure, non-PV triggers were ablated in all. Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non-PV triggers were detected. Results: PV reconnection was detected in 226 and non-PV triggers were identified or empirically isolated in 285 patients during the index procedure. At follow-up, 182 (60%) patients were recurrence-free off-AAD; the success rate with and without non-PV ablation was 81% vs. 8% (P < 0.0001). 104 patients underwent repeat procedure with non-PV trigger ablation in all. At 1 year, 90% were arrhythmia free off-AAD in non-PV ablation group, and 72% who did not receive non-PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5% and 82% after the index and repeat procedure, respectively. Conclusion: In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non-PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non-PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia-free survival.

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2017

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Catheter Ablation
Atrial Fibrillation
Coronary Sinus
Isoproterenol
Cardiac Arrhythmias
Recurrence
Maintenance
Survival

Keywords

  • Atrial fibrillation
  • Empirical isolation
  • Non-PV triggers
  • PV reconnection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations. / Mohanty, Sanghamitra; Trivedi, Chintan; Gianni, Carola; Della Rocca, Domenico Giovanni; Morris, Eli Hamilton; Burkhardt, J. David; Sanchez, Javier E.; Horton, Rodney; Gallinghouse, G. Joseph; Hongo, Richard; Beheiry, Salwa; Al-Ahmad, Amin; Di Biase, Luigi; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, 2017.

Research output: Contribution to journalArticle

Mohanty, S, Trivedi, C, Gianni, C, Della Rocca, DG, Morris, EH, Burkhardt, JD, Sanchez, JE, Horton, R, Gallinghouse, GJ, Hongo, R, Beheiry, S, Al-Ahmad, A, Di Biase, L & Natale, A 2017, 'Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.13329
Mohanty, Sanghamitra ; Trivedi, Chintan ; Gianni, Carola ; Della Rocca, Domenico Giovanni ; Morris, Eli Hamilton ; Burkhardt, J. David ; Sanchez, Javier E. ; Horton, Rodney ; Gallinghouse, G. Joseph ; Hongo, Richard ; Beheiry, Salwa ; Al-Ahmad, Amin ; Di Biase, Luigi ; Natale, Andrea. / Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations. In: Journal of Cardiovascular Electrophysiology. 2017.
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abstract = "Introduction: This study reports the procedural findings and ablation outcome in AF patients referred after ≥2 failed PV isolation (PVI). Methods: Three hundred and five consecutive AF patients referred after ≥2 PVI were included in the analysis. High-dose isoproterenol challenge was used to identify PV reconnection and non-PV triggers; the latter were ablated based on the operator's discretion during the index procedure. At the repeat procedure, non-PV triggers were ablated in all. Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non-PV triggers were detected. Results: PV reconnection was detected in 226 and non-PV triggers were identified or empirically isolated in 285 patients during the index procedure. At follow-up, 182 (60{\%}) patients were recurrence-free off-AAD; the success rate with and without non-PV ablation was 81{\%} vs. 8{\%} (P < 0.0001). 104 patients underwent repeat procedure with non-PV trigger ablation in all. At 1 year, 90{\%} were arrhythmia free off-AAD in non-PV ablation group, and 72{\%} who did not receive non-PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5{\%} and 82{\%} after the index and repeat procedure, respectively. Conclusion: In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non-PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non-PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia-free survival.",
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T1 - Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations

AU - Mohanty, Sanghamitra

AU - Trivedi, Chintan

AU - Gianni, Carola

AU - Della Rocca, Domenico Giovanni

AU - Morris, Eli Hamilton

AU - Burkhardt, J. David

AU - Sanchez, Javier E.

AU - Horton, Rodney

AU - Gallinghouse, G. Joseph

AU - Hongo, Richard

AU - Beheiry, Salwa

AU - Al-Ahmad, Amin

AU - Di Biase, Luigi

AU - Natale, Andrea

PY - 2017

Y1 - 2017

N2 - Introduction: This study reports the procedural findings and ablation outcome in AF patients referred after ≥2 failed PV isolation (PVI). Methods: Three hundred and five consecutive AF patients referred after ≥2 PVI were included in the analysis. High-dose isoproterenol challenge was used to identify PV reconnection and non-PV triggers; the latter were ablated based on the operator's discretion during the index procedure. At the repeat procedure, non-PV triggers were ablated in all. Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non-PV triggers were detected. Results: PV reconnection was detected in 226 and non-PV triggers were identified or empirically isolated in 285 patients during the index procedure. At follow-up, 182 (60%) patients were recurrence-free off-AAD; the success rate with and without non-PV ablation was 81% vs. 8% (P < 0.0001). 104 patients underwent repeat procedure with non-PV trigger ablation in all. At 1 year, 90% were arrhythmia free off-AAD in non-PV ablation group, and 72% who did not receive non-PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5% and 82% after the index and repeat procedure, respectively. Conclusion: In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non-PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non-PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia-free survival.

AB - Introduction: This study reports the procedural findings and ablation outcome in AF patients referred after ≥2 failed PV isolation (PVI). Methods: Three hundred and five consecutive AF patients referred after ≥2 PVI were included in the analysis. High-dose isoproterenol challenge was used to identify PV reconnection and non-PV triggers; the latter were ablated based on the operator's discretion during the index procedure. At the repeat procedure, non-PV triggers were ablated in all. Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non-PV triggers were detected. Results: PV reconnection was detected in 226 and non-PV triggers were identified or empirically isolated in 285 patients during the index procedure. At follow-up, 182 (60%) patients were recurrence-free off-AAD; the success rate with and without non-PV ablation was 81% vs. 8% (P < 0.0001). 104 patients underwent repeat procedure with non-PV trigger ablation in all. At 1 year, 90% were arrhythmia free off-AAD in non-PV ablation group, and 72% who did not receive non-PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5% and 82% after the index and repeat procedure, respectively. Conclusion: In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non-PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non-PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia-free survival.

KW - Atrial fibrillation

KW - Empirical isolation

KW - Non-PV triggers

KW - PV reconnection

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DO - 10.1111/jce.13329

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JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

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