Recurrence of Atrial Arrhythmias Despite Persistent Pulmonary Vein Isolation After Catheter Ablation for Atrial Fibrillation: A Case Series

Samuel H. Baldinger, Jason S. Chinitz, Sunil Kapur, Saurabh Kumar, Chirag R. Barbhaiya, Akira Fujii, Jorge E. Romero, Laurence M. Epstein, Roy John, Usha B. Tedrow, William G. Stevenson, Gregory F. Michaud

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives The aim of this study was to categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent pulmonary vein isolation (PVI) at the time of redo procedures. Background Persistent PVI is more frequently seen in patients undergoing redo procedures for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF). Methods Consecutive patients who underwent their first AF ablation procedures at Brigham and Women's Hospital were screened and included if they had persistent isolation of all pulmonary veins at the time of redo procedures. Results Of 300 consecutive patients undergoing first AF ablation procedures, redo procedures were performed in 63 (21%), and 26 patients (9%) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure, linear ablation was performed in 46% of patients with recurrent AF and 93% with recurrent organized AT (p = 0.020). At the time of last follow-up, 2 of 10 patients (20%) in the AF group and 10 of 15 patients (67%) in AT group were in sinus rhythm, without class I or III antiarrhythmic drugs (p = 0.022). Conclusions Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized AT. Linear ablation during the index procedure is associated with recurrence of organized AT. Recurrence rates after redo procedures were higher if patients had recurrent AF after the index procedure, and these patients often presented with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.

Original languageEnglish (US)
Pages (from-to)723-731
Number of pages9
JournalJACC: Clinical Electrophysiology
Volume2
Issue number6
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Fingerprint

Catheter Ablation
Pulmonary Veins
Atrial Fibrillation
Cardiac Arrhythmias
Recurrence
Tachycardia
Anti-Arrhythmia Agents

Keywords

  • atrial arrhythmias
  • atrial fibrillation
  • catheter ablation
  • outcome
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Recurrence of Atrial Arrhythmias Despite Persistent Pulmonary Vein Isolation After Catheter Ablation for Atrial Fibrillation : A Case Series. / Baldinger, Samuel H.; Chinitz, Jason S.; Kapur, Sunil; Kumar, Saurabh; Barbhaiya, Chirag R.; Fujii, Akira; Romero, Jorge E.; Epstein, Laurence M.; John, Roy; Tedrow, Usha B.; Stevenson, William G.; Michaud, Gregory F.

In: JACC: Clinical Electrophysiology, Vol. 2, No. 6, 01.11.2016, p. 723-731.

Research output: Contribution to journalArticle

Baldinger, SH, Chinitz, JS, Kapur, S, Kumar, S, Barbhaiya, CR, Fujii, A, Romero, JE, Epstein, LM, John, R, Tedrow, UB, Stevenson, WG & Michaud, GF 2016, 'Recurrence of Atrial Arrhythmias Despite Persistent Pulmonary Vein Isolation After Catheter Ablation for Atrial Fibrillation: A Case Series', JACC: Clinical Electrophysiology, vol. 2, no. 6, pp. 723-731. https://doi.org/10.1016/j.jacep.2016.05.013
Baldinger, Samuel H. ; Chinitz, Jason S. ; Kapur, Sunil ; Kumar, Saurabh ; Barbhaiya, Chirag R. ; Fujii, Akira ; Romero, Jorge E. ; Epstein, Laurence M. ; John, Roy ; Tedrow, Usha B. ; Stevenson, William G. ; Michaud, Gregory F. / Recurrence of Atrial Arrhythmias Despite Persistent Pulmonary Vein Isolation After Catheter Ablation for Atrial Fibrillation : A Case Series. In: JACC: Clinical Electrophysiology. 2016 ; Vol. 2, No. 6. pp. 723-731.
@article{8c89e005e43f448bae57c85d76f7f606,
title = "Recurrence of Atrial Arrhythmias Despite Persistent Pulmonary Vein Isolation After Catheter Ablation for Atrial Fibrillation: A Case Series",
abstract = "Objectives The aim of this study was to categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent pulmonary vein isolation (PVI) at the time of redo procedures. Background Persistent PVI is more frequently seen in patients undergoing redo procedures for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF). Methods Consecutive patients who underwent their first AF ablation procedures at Brigham and Women's Hospital were screened and included if they had persistent isolation of all pulmonary veins at the time of redo procedures. Results Of 300 consecutive patients undergoing first AF ablation procedures, redo procedures were performed in 63 (21{\%}), and 26 patients (9{\%}) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure, linear ablation was performed in 46{\%} of patients with recurrent AF and 93{\%} with recurrent organized AT (p = 0.020). At the time of last follow-up, 2 of 10 patients (20{\%}) in the AF group and 10 of 15 patients (67{\%}) in AT group were in sinus rhythm, without class I or III antiarrhythmic drugs (p = 0.022). Conclusions Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized AT. Linear ablation during the index procedure is associated with recurrence of organized AT. Recurrence rates after redo procedures were higher if patients had recurrent AF after the index procedure, and these patients often presented with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.",
keywords = "atrial arrhythmias, atrial fibrillation, catheter ablation, outcome, pulmonary vein isolation",
author = "Baldinger, {Samuel H.} and Chinitz, {Jason S.} and Sunil Kapur and Saurabh Kumar and Barbhaiya, {Chirag R.} and Akira Fujii and Romero, {Jorge E.} and Epstein, {Laurence M.} and Roy John and Tedrow, {Usha B.} and Stevenson, {William G.} and Michaud, {Gregory F.}",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.jacep.2016.05.013",
language = "English (US)",
volume = "2",
pages = "723--731",
journal = "JACC: Clinical Electrophysiology",
issn = "2405-5018",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - Recurrence of Atrial Arrhythmias Despite Persistent Pulmonary Vein Isolation After Catheter Ablation for Atrial Fibrillation

T2 - A Case Series

AU - Baldinger, Samuel H.

AU - Chinitz, Jason S.

AU - Kapur, Sunil

AU - Kumar, Saurabh

AU - Barbhaiya, Chirag R.

AU - Fujii, Akira

AU - Romero, Jorge E.

AU - Epstein, Laurence M.

AU - John, Roy

AU - Tedrow, Usha B.

AU - Stevenson, William G.

AU - Michaud, Gregory F.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Objectives The aim of this study was to categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent pulmonary vein isolation (PVI) at the time of redo procedures. Background Persistent PVI is more frequently seen in patients undergoing redo procedures for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF). Methods Consecutive patients who underwent their first AF ablation procedures at Brigham and Women's Hospital were screened and included if they had persistent isolation of all pulmonary veins at the time of redo procedures. Results Of 300 consecutive patients undergoing first AF ablation procedures, redo procedures were performed in 63 (21%), and 26 patients (9%) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure, linear ablation was performed in 46% of patients with recurrent AF and 93% with recurrent organized AT (p = 0.020). At the time of last follow-up, 2 of 10 patients (20%) in the AF group and 10 of 15 patients (67%) in AT group were in sinus rhythm, without class I or III antiarrhythmic drugs (p = 0.022). Conclusions Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized AT. Linear ablation during the index procedure is associated with recurrence of organized AT. Recurrence rates after redo procedures were higher if patients had recurrent AF after the index procedure, and these patients often presented with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.

AB - Objectives The aim of this study was to categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent pulmonary vein isolation (PVI) at the time of redo procedures. Background Persistent PVI is more frequently seen in patients undergoing redo procedures for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF). Methods Consecutive patients who underwent their first AF ablation procedures at Brigham and Women's Hospital were screened and included if they had persistent isolation of all pulmonary veins at the time of redo procedures. Results Of 300 consecutive patients undergoing first AF ablation procedures, redo procedures were performed in 63 (21%), and 26 patients (9%) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure, linear ablation was performed in 46% of patients with recurrent AF and 93% with recurrent organized AT (p = 0.020). At the time of last follow-up, 2 of 10 patients (20%) in the AF group and 10 of 15 patients (67%) in AT group were in sinus rhythm, without class I or III antiarrhythmic drugs (p = 0.022). Conclusions Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized AT. Linear ablation during the index procedure is associated with recurrence of organized AT. Recurrence rates after redo procedures were higher if patients had recurrent AF after the index procedure, and these patients often presented with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.

KW - atrial arrhythmias

KW - atrial fibrillation

KW - catheter ablation

KW - outcome

KW - pulmonary vein isolation

UR - http://www.scopus.com/inward/record.url?scp=84996836192&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84996836192&partnerID=8YFLogxK

U2 - 10.1016/j.jacep.2016.05.013

DO - 10.1016/j.jacep.2016.05.013

M3 - Article

AN - SCOPUS:84996836192

VL - 2

SP - 723

EP - 731

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

SN - 2405-5018

IS - 6

ER -