Atrial arrhythmias following ostial or circumferential pulmonary vein ablation

Abstract

The incidence, clinical significance and optimum treatment of AF ablation-induced proarrhythmia is not entirely known. This report describes the incidence and management of atrial arrhythmias occurring after various techniques for the ablative therapy of atrial fibrillation (AF). Five hundred and forty-four patients with paroxysmal atrial fibrillation were subjected to ostial pulmonary vein (PV) (n = 204), antral (n = 300), or circumferential (n = 40) ablation around the PV ostia. Atrial tachycardia or flutter during the first 6 months after AF ablation was detected in 14 patients and was more common among patients subjected to circumferential or circumferential and linear ablation (18% and 22%, respectively) than to other techniques (p < 0.001). The risk of atrial tachycardia or flutter among patients who underwent ostial, ostial with lines and antral ablation was 1%, 8% and 1%, respectively. No difference was observed in the risk of atrial arrhythmia between patients who underwent ablation with or without additional lines, either ostial (p = 0.17) or circumferential (p = 0.99). Re-ablation was performed in patients with sustained atrial arrhythmia (11 out of 14 patients). At 6 months, no recurrence was seen in 10 of these patients as well as in 3 patients with non-sustained atrial tachycardia or flutter. The incidence of atrial tachycardia or flutter following AF ablation is lower for ostial than circumferential ablation. The addition of lines along the mitral isthmus and between the superior PVs does not significantly affect the risk of ablation-induced arrhythmia. Non-sustained atrial tachycardia or flutter following AF ablation procedures does not always require additional ablation.