Recurrence after “long-term success” in catheter ablation of paroxysmal atrial fibrillation

Abstract

The latest guidelines define "long-term success" as freedom from atrial arrhythmia recurrence more than 36 months after procedures without any antiarrhythmic drug therapy. The purpose of this study was to investigate the clinical outcomes and procedural findings in patients with recurrence beyond "long-term success." Among patients who underwent pulmonary vein (PV) antrum isolation for drug-refractory symptomatic paroxysmal atrial fibrillation (AF), 37 in whom recurrent arrhythmias were observed during annual follow-up after "long-term success" and who underwent repeat procedures for recurrent arrhythmias were included in the study. The time from the latest procedure to recurrence was a median of 61 ([25th, 75th percentiles]: [51-77.5]) months. Recurrent arrhythmia type was paroxysmal in 22 patients (59.5%) and persistent in 15 (40.5%). Recurrent arrhythmias were atrial tachycardia (AT) in 13 patients (35.1%), including 8 with AT unrelated to PVs. Repeat procedures were performed a median of 2.0 [1.0-4.0] months after identifying recurrent episodes. Recovered PV conduction was found in 29 patients (78.4%) and non-PV foci in 4 (10.8%). Freedom from recurrence 1 year after repeat procedures was 63.3%. Seven patients (18.9%) underwent further repeat procedures a median of 7.0 [2.0-28.0] months after repeat procedures and had no PV reconnections. In total, AF/AT unrelated to PVs was present in 24 patients (64.9%). In contrast, arrhythmias related to PVs were observed in 2 patients (5.4%) during a total of 46 repeat procedures after "long-term success." Although PV reconnections were commonly found even after "long-term success," AF/AT unrelated to PVs was assumed to be present in the majority of this population.