Characteristics and outcomes of recurrent atrial fibrillation after prior failed pulmonary vein isolation
| العنوان: | Characteristics and outcomes of recurrent atrial fibrillation after prior failed pulmonary vein isolation |
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| المؤلفون: | Sai Vanam, Douglas Darden, Muhammad Bilal Munir, Omar Aldaas, Jonathan C. Hsu, Frederick T. Han, Kurt S. Hoffmayer, Farshad Raissi, Ulrika Birgersdotter-Green, Gregory K. Feld, David E. Krummen, Gordon Ho |
| المصدر: | Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, vol 64, iss 3 |
| بيانات النشر: | Springer Science and Business Media LLC, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | screening and diagnosis, Atrial tachycardia, Middle Aged, Cardiorespiratory Medicine and Haematology, Cardiovascular, Atrial fibrillation, Pulmonary vein isolation, Detection, Treatment Outcome, Heart Disease, Mapping, Cardiovascular System & Hematology, Pulmonary Veins, Recurrence, Physiology (medical), Catheter Ablation, Humans, Cardiology and Cardiovascular Medicine, Retrospective Studies, Aged, 4.2 Evaluation of markers and technologies |
| الوصف: | Background The mechanisms for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) catheter ablation are unclear. Non-PV organized atrial arrhythmias (PAC, AT, macro-reentrant AFL) are possible contributors; however the prevalence and effect of their ablation on recurrent AF are unknown. We hypothesize that the identification and ablation of non-PV organized atrial arrhythmias were associated with less AF recurrence. Methods Patients who underwent repeat ablation for recurrent AF after prior PVI were retrospectively enrolled. The prevalence and characteristics of PV reconnections and non-PV organized atrial arrhythmias were identified. The outcomes of time to clinical AF recurrence, heart failure (HF) hospitalization, and mortality were analyzed in patients using multivariable adjusted Cox regression. Results In 74 patients with recurrent AF (age 66 ± 9 years, left atrial volume index 38 ± 10 ml/m2, 59% persistent AF), PV reconnections were found in 46 patients (61%), macro-reentrant atrial flutter in 27 patients (36%), and focal tachycardia in 12 patients (16%). Mapping and ablation of non-PV organized atrial arrhythmias were associated with a reduced recurrence of late clinical AF (adjusted HR 0.26, CI 0.08–0.85, p = 0.03) and the composite outcome of recurrence of late AF, HF hospitalization, and mortality (adjusted HR 0.38, CI 0.17–0.85, p = 0.02), with median follow-up of 1.6 (IQR 0.7–6.3) years. The presence of PV reconnections or empiric linear ablation was not associated with reduction in clinical AF or composite endpoints. Conclusion The ablation of non-PV organized atrial arrhythmias resulted in a reduction of late clinical AF recurrence and composite outcome. In this challenging population, alternate mechanisms beyond PV reconnections need to be considered. Prospective studies are needed. |
| وصف الملف: | application/pdf |
| تدمد: | 1572-8595 1383-875X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c8611850280911b08f14b69a9d757064Test https://doi.org/10.1007/s10840-022-01160-wTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....c8611850280911b08f14b69a9d757064 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15728595 1383875X |
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