Abstract

Background and objectivesCatheter ablation of atrial fibrillation (AF) has become a well-established and widely used therapy, with pulmonary vein isolation (PVI) being the key modality of ablation. However, arrhythmia recurrences after PVI are common, with a relevant number of patients undergoing repeat ablation. Arrhythmia recurrence after PVI may vary regarding time point and mode of recurrence. While early arrhythmia recurrences of AF after PVI are mostly found to be the product of electrical reconnection of the pulmonary veins, the exact mechanisms of very late arrhythmia recurrence, occurring later than 12 months after successful PVI, remain unclear. This review provides an overview on the current evidence on time point and mechanisms of arrhythmia recurrence after PVI focussing on late arrhythmia recurrence.Recent findingsThe incidence of late arrhythmia recurrence after PVI can lie at a rate of up to 30% according to long-term follow-up studies. Mechanisms of recurrence include electrical reconnection of previously isolated pulmonary veins and development of atrial fibrosis. The use of cryoballoon ablation is likely to be more effective in reducing late arrhythmia recurrences compared to radiofrequency ablation. Novel scores such as the MB-LATER score or the APPLE score may become useful tools in predicting arrhythmia recurrence after PVI.Results and conclusionLate arrhythmia recurrence after PVI is common and leads to a relevant impairment of long-term success. Relevant data are currently limited and exact mechanisms of arrhythmia recurrence remain unclear. Further studies are needed to elucidate pathogenetic mechanisms of late arrhythmia recurrence after PVI in order to improve treatment strategies.

Highlights

  • Catheter ablation has become an accepted first line therapy for paroxysmal atrial fibrillation (PAF), with pulmonary vein isolation (PVI) being the key element of ablation strategies [1, 2]

  • This review provides an overview on the current evidence on time point and mechanisms of arrhythmia recurrence after PVI focussing on late arrhythmia recurrence

  • Recent findings: The incidence of late arrhythmia recurrence after PVI can lie at a rate of up to 30% according to long-term follow-up studies

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Summary

Introduction

Catheter ablation has become an accepted first line therapy for paroxysmal atrial fibrillation (PAF), with pulmonary vein isolation (PVI) being the key element of ablation strategies [1, 2]. Catheter ablation of AF has been proven to be superior to antiarrhythmic drug (AAD) therapy regarding efficacy and improvement of survival in patients with heart failure [3, 4]. Early recurrence of AF (ERAF) within the first 3 months after PVI using radiofrequency (RF) energy is a clinically relevant problem with up to 35% of patients needing repeat ablation procedures [5, 6]. Arrhythmia recurrence within the first 3 months after PVI is mostly associated with early inflammation, incomplete

Reference Number of Underlying patients arrhythmia
Efficacy of AF ablation
Early arrhythmia recurrence
Incidence of very late arrhythmia recurrence
Mechanisms of early and late arrhythmia recurrence after ablation
Influence of the ablation approach on AF recurrences
Prediction of arrhythmia recurrences
Conclusion
Findings
Corresponding address
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