Abstract
IntroductionRecurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV). We investigated spatial distribution of electrical reconnection during re-do procedures in patients with paroxysmal atrial fibrillation who had previous successful acute electrical PVI with either single irrigated tip, antral ablation (s-RF; n = 38) or multi-electrode, duty-cycled ablation (PVAC; n = 48).Methods and ResultsEP navigator, mapping and irrigated tip ablation catheters were used in all re-do procedures. Sites of reconnection were assessed in a 12-segment model. Baseline clinical and demographic characteristics were similar in both groups. The number of PVs reconnected per patient was similar in both groups (2.9 ± 0.9 and 3.2 ± 0.7 (p = 0.193), s‑RF and PVAC, respectively), and each PV was equally affected. However, the inferior quadrant of the right lower PV was significantly more vulnerable to reconnection after previous PVAC ablation, whereas the superior quadrant of the right upper PV showed significantly more reconnection in the s‑RF group.ConclusionThe overall number of PVs reconnected was equally high in both groups, and each PV was affected equally. However, there were significant differences in the spatial distribution of electrical reconnection. Better understanding of predilection sites for reconnection might help to improve the long-term success rate of PVI.
Highlights
Recurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV)
We investigated the number of PV reconnections and its spatial distribution after two different techniques used for PVI for the index procedure, i. e. single irrigated tip, antral ablation (s-RF) and multi-electrode, duty-cycled ablation (PVAC)
The duration of RFenergy application for re-isolation was distributed between the PVs (Tab. 2) and there were no spatial differences with respect to the 12-segment model. This is the first study comparing reconnection patterns of two commonly used ablation techniques and its main findings are: (1) reconnection occurred in all studied patients and, on average, 3 out of 4 PVs were reconnected; (2) reconnection occurred among PVs and irrespective of the initial ablation technique, the superior region of the right upper PV is a predilection site for reconnection after single point RF ablation as compared with the inferior region of the right lower PV after a previous PVAC procedure; (3) the duration of RF-energy application necessary to re-isolate a site of reconnection is similar in both groups
Summary
Recurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV). Various techniques have been applied to electrically disconnect the pulmonary veins (PVs) from the adjacent atrium (reviewed in Dewire et al [1]) These techniques are often successful in achieving acute electrical isolation of the PVs, in the long term success is still low with up to 30 % of patients with paroxysmal AF suffering recurrence of AF within 2 years after PVI [2]. This recurrence may be related to recovery of electrical conduction in a previously isolated pulmonary vein (PV). Non-PV foci [3, 5,6,7] and changes in the atrial substrate due to coexistent diseases such as arterial hypertension or diabetes may cause recurrent AF [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
