Abstract 11177: Pulmonary Vein Reconnections Predict Good Clinical Outcomes After a Second Catheter Ablation of Persistent Atrial Fibrillation: Insight From the EARNEST-PVI Trial

Abstract

Introduction: The effect of an extensive ablation strategy in addition to pulmonary vein (PV) isolation is still controversial in persistent atrial fibrillation (AF) ablation. Electrical PV reconnection is an important confounder affecting the trial results. Objectives: To evaluate the PV reconnection rate and association between the reconnection and AF recurrence after a re-do AF ablation in the EARNEST-PVI trial (NCT03514693). Methods: The analysis was performed using the extended data of the EARNEST-PVI trial (N=512), a randomized controlled trial to evaluate ablation strategies for persistent AF, which was conducted in the Osaka region of Japan. During a median follow-up of 47 months, a total of 126 (25%) patients underwent a re-do AF ablation. Among them, 120 (median age, 68 years; 36% female; 31% long-standing persistent AF, 95% contact force-sensing catheter use) whose follow-up data were available after the 2 nd AF ablation were enrolled in this study. Results: PV reconnections were observed in 75 (63%) patients. Although there was no difference in age, gender, long-standing persistent AF, and CA strategy during the index procedure, AF recurrence within 1 year was more frequent in patients with PV reconnections (81.3% vs. 64.4%, p = 0.039). During a median follow-up of 31 months after the re-do AF ablation, patients with PV reconnections had a lower clinical recurrence rate than those without (38.7 vs. 44.4%, log-rank p = 0.047). However, additional linear ablation did not affect the recurrence rate. Even after adjustment for age, gender, long-standing persistent AF, and presence of non-PV triggers, Cox regression analysis revealed that a number of reconnected PVs of ≥2 was independently associated with a lower recurrence of AF after the 2 nd AF ablation (hazard ratio, 0.36; 95% confidence interval, 0.19-0.67; p = 0.001). Conclusions: Among patients who underwent a redo-AF ablation in the EARNEST-PVI trial, about two-thirds exhibited PV reconnections. Patients with ≥2 PV reconnections had better clinical outcomes than those with ≤1 PV reconnections. A durable PV isolation is an important pre-requisite before exploring any additional ablation strategies for persistent AF.