Evolution of post-pulmonary vein isolation atrial fibrillation inducibility at redo ablation: Electrophysiological evidence of extra-pulmonary vein substrate progression

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Nicolas JohnerMehdi Namdar

Abstract

The electrophysiological substrate underlying atrial fibrillation (AF) progression remains difficult to identify. The goals of this study were to study the evolution of post-pulmonary vein isolation (PVI) AF inducibility (AFI) after AF ablation and to compare patients with organized atrial tachycardia recurrence (OATr) versus those with paroxysmal or persistent AF recurrence. We studied 99 patients who underwent de novo AF ablation (p1) and redo ablation (p2) for AF recurrence (AFr) or OATr. Stepwise AF ablation was performed at p1 and p2: (1) PVI, (2) coronary sinus defragmentation, and (3) left atrial (LA) defragmentation. Burst pacing followed each step, with AFI defined as sustained AF >5 minutes, triggering the next step. Patients with OATr underwent OAT ablation and inducibility testing post-redo PVI. Inducibility progression (IP) was defined as AFI at further steps of p2 compared to p1. Among patients with AFr, 34 of 72 patients (47%) exhibited post-PVI IP vs 2 of 27 (7.4%) patients with OATr (P = .0002). Stratification for persistent AF/paroxysmal AF/OATr showed a consistent association between recurrence phenotype and IP. Pulmonary vein (PV) reconnection incidence was 90%, without association with recurrence type or IP...Continue Reading

Citations

Aug 30, 2019·Arrhythmia & Electrophysiology Review·Nicolas JohnerDipen C Shah
Oct 16, 2020·Journal of Cellular and Molecular Medicine·Jing LiXinchun Yang
Mar 21, 2021·Pacing and Clinical Electrophysiology : PACE·Cheryl TeresAntonio Berruezo

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