AB-453070-4 INCREMENTAL EFFICACY FOR REPEAT ABLATION PROCEDURES FOR CATHETER ABLATION OF ATRIAL FIBRILLATION: 5-YEAR FOLLOW-UP

Abstract

Catheter ablation has emerged as an effective strategy for the treatment of Atrial fibrillation (AF) but 20-40% of patients will require a repeat ablation. While one repeat ablation is considered clinically useful, the role of more than one repeat is not well known over long-term follow-up. Excessive repeat ablation can limit access to patients who need their first ablation. We aimed to describe the outcome of one or more repeat AF ablations in a large cohort of paroxysmal and persistent AF patients. We retrospectively included patients who underwent their first, second, third and fourth AF ablation at our center between 2005 and 2019. Wide-antral pulmonary vein isolation (PVI) was performed in all patients. Posterior wall isolation was left to the discretion of the operator but was used in almost all persistent patients. Patient demographics, medical history, procedural details, and complications were collected in a database. Patients were monitored with a 24-to-48-hour Holter every three months for the first year after each ablation with follow-ups every 6-12 months thereafter. Freedom from atrial arrhythmia was evaluated after each AF ablation. We included 2895 patients that underwent catheter ablation for AF at our institution. From them, 1809 (62.5%) had paroxysmal AF, 950 (32.8%) had persistent AF and 136 (4.7%) long persistent AF. Age was 61 ± 10 years, left atrial diameter was 42 ± 6 mm, and radiofrequency was used for 97% of procedures. After one ablation, freedom from atrial arrhythmias was 52%. Among those 1052 patients that had a recurrence, 576 (55%) underwent a second AF ablation procedure, 103 (10%) underwent a third procedure and 20 (2%) underwent a fourth. Success rates for the second, third and fourth ablation were 57%, 60% and 40% respectively. The success rates for repeat procedures for paroxysmal and persistent patients separately are provided in the Table. After the second ablation, freedom from atrial arrhythmia in our entire cohort significantly improved from 52% to 67% (p<0.001). However, incremental benefit did not change much after the third (68%; p=0.35) and fourth ablation (69%; p=0.8) (Figure). The success rate of repeat ablations drops off after a third procedure, regardless of AF type. In the entire cohort, the population success rate changes significantly from the first to second procedure, but not appreciably so for more than 2 procedures.Tabled 1Second Ablation Success (%)Third Ablation Success (%)Fourth Ablation Success (%)Paroxysmal AF56.5%60.4%41.7%Persistent and Long-standing persistent AF56.9%59.3%37.5% Open table in a new tab