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Predictors of long-term outcome in patients undergoing a first repeat ablation for atrial fibrillation consisting solely of re-isolation of reconnected pulmonary veins.

Session Moderated ePosters 3: atrial fibrillation ablation: dealing with gaps and safety

Speaker Juan-Pablo Abugattas

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Rhythm Control, Catheter Ablation
  • Session type : Moderated Posters
  • FP Number : 77

Authors : J P Abugattas (Antwerp,BE), B Schwagten (Antwerp,BE), J De Cocker (Antwerp,BE), HE Coutino (Brussels,BE), F Salghetti (Brussels,BE), V Varnavas (Antwerp,BE), E Stroker (Brussels,BE), J Sieira (Brussels,BE), M Wolf (Antwerp,BE), P Brugada (Brussels,BE), C De Asmundis (Brussels,BE), GB Chierchia (Brussels,BE), Y De Greef (Antwerp,BE)

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Authors:
J P Abugattas1 , B Schwagten1 , J De Cocker1 , HE Coutino2 , F Salghetti2 , V Varnavas1 , E Stroker2 , J Sieira2 , M Wolf1 , P Brugada2 , C De Asmundis2 , GB Chierchia2 , Y De Greef1 , 1ZNA Middelheim Hospital, Hartcentrum ZNA, Electrophysiology Unit. - Antwerp - Belgium , 2Free University of Brussels (VUB), Heart Rhythm Management Centre - Brussels - Belgium ,

Citation:

Aims: To define predictors of long-term outcome of a first repeat ablation solely consisting of re-isolation of reconnected pulmonary veins (PVs).

Methods: Three hundred seven patients (age 59 ± 9 years, 77% males, 43% non-paroxysmal AF) with recurrent AF after first PVI were studied. Re-isolation of reconnected PVs was guided by a circular mapping catheter and 3D mapping system using RF ablations. A PV was defined as "triggering" in case of spontaneous ectopy or AF paroxysms originating from the PV.

Results: After a mean follow-up of 5.05 ± 2.21 years, 194 (63.2%) patients (73.0% in PAF vs 50.4% in non-PAF, log Rank <0.001) were free from AF. A "triggering" PV was present in 48 (15.6%) during the first PVI and in 52 (16.9%) at repeat. At baseline, out of 1208 studied PVs, 837 (69.29%) were reconnected: LCPV 21/25 (84.0%), LSPV 182/282 (64.5%), LIPV 197/282 (69.9%), RSPV 217/307 (70.7%), and RIPV 220/307 (71.7%). The mean number of reconnected PVs per patient was 2.73 ± 1.01.  Independent predictors of recurrence were a non-PAF type (HR: 1.814, 95%CI: 1.090 - 3.018, p=0.022) and early recurrence (= 3 months) after first PVI (HR: 1.632, 95%CI: 1.091 - 2.443, p=0.017) while a "triggering" PV at first or repeat was a predictor of good outcome (HR: 0.574; 95%CI: 0.344 - 0.959; p=0.034) in the multivariable analysis.

Conclusions:

A repeat ablation solely consisting of re-isolation of reconnected PVs results in a high degree of long term AF freedom, especially in PAF and in case of a PV trigger at index or repeat. Patients with non-PAF or experiencing early AF recurrence after first PVI are less responsive.

Univariate Analysis

Multivariate Analysis

p

HR

95% CI

p

HR

95.% CI

Left atrial diameter*

0.032

1.032

1.003 - 1.062

0.426

1.013

0.982 - 1.044

Identified PV trigger at index or repeat

0.022

0.575

0.358 - 0.925

0.034

0.574

0.344 - 0.959

Need for > 1 ECV before first PVI

0.000

2.360

1.605 - 3.470

0.391

1.249

0.751 - 2.078

Non paroxysmal AF

0.000

2.382

1.633 - 3.475

0.022

1.814

1.090 - 3.018

Recurrence 3 months after the first PVI

0.036

1.512

1.027 - 2.228

0.017

1.632

1.091 - 2.443

LSPV reconnection

0.595

0.897

0.600 - 1.340

LIPV reconnection

0.990

0.997

0.652 - 1.526

RSPV reconnection

0.619

1.112

0.732 - 1.688

RIPV reconnection

0.646

0.910

0.607 - 1.363

Number of PV's reconnected 0.629 0.957 0.801 - 1.144

The free consultation period for this content is over.

It is now only available year-round to EHRA Ivory (& above) Members, Fellows of the ESC and Young combined Members



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