PO-710-04 CONTEMPORARY PREVALENCE AND PREDICTORS OF INTACT PULMONARY VEIN ISOLATION IN PATIENTS UNDERGOING REPEAT ATRIAL FIBRILLATION ABLATION

Abstract

Pulmonary vein isolation (PVI) is the primary goal of atrial fibrillation (AF) ablation. Prior studies have noted a 50-95% prevalence of pulmonary vein (PV) reconnection at the time of repeat ablation. However, the prevalence of PV reconnection with contemporary AF ablation techniques, including high frequency jet ventilation, is unknown. Furthermore, there is an incomplete understanding of predictors of intact PVI at the time of repeat ablation. To assess the prevalence of PV reconnection in a contemporary cohort utilizing jet ventilation, contact force catheters, and adenosine testing for dormant conduction, and identify patient characteristics and ablation techniques that predict PVI at time of repeat ablation. We reviewed 615 consecutive radiofrequency AF ablations from 2013-2019 at an academic medical center performed by a single operator. There were 121 unique patients who underwent a de novo AF ablation followed by a repeat AF ablation. We evaluated clinical and previous procedural characteristics to identify predictors of PVI at the time of repeat ablation, using logistic regression models. Of the 121 patients, 42.1% were female, average age was 64.5 years, and BMI 31. At the time of repeat ablation, 57% (n=69) had intact prior PVI. Baseline characteristics of patients with intact PVI and reconnected PVI were similar, including age (64 years and 65 years; p=0.75), left atrial diameter (4.13 cm and 4.39 cm; p=0.09), left ventricular ejection fraction (54.5 % and 55.4%; p = 0.38), and time to first atrial fibrillation recurrence (237 days v. 344 days, p=0.28). The only significant clinical predictor of intact PVI was the pre-procedure diagnosis of atypical atrial flutter (20.3 % v. 3.8%, p=0.02) (Figure 1). In multivariate analysis, prior mitral line ablation (OR 8.93, 95%CI [3.65, 21.87]: p <0.01) and first pass isolation of right pulmonary vein during the index AF ablation (OR 2.59, 95% CI [1.09, 6.12]: p = 0.03) strongly predicted intact PVI at the time of repeat AF ablation. With contemporary techniques, PVI reconnection is seen in 43% of patients at the time of repeat AF ablation. History of atypical flutter, prior mitral line ablation, and first pass isolation of the right PVs were significant predictors for intact PVI.