Clinical outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION: High recurrence rate is still a major problem associated with ablation of paroxysmal atrial fibrillation (AF). Most of the recurrences occur within 6 months after ablation. The characteristics of very late recurrent AF (>12 months after ablation) have not been reported. METHODS AND RESULTS: Two hundred seven patients with drug-refractory AF underwent successful focal ablation or isolation of AF foci. After the first ablation procedure, Holter monitoring and event recorders were used to evaluate symptomatic recurrent AF. A second ablation procedure was recommended if the antiarrhythmic drugs could not control recurrent AF. During long-term follow-up (mean 30 +/- 11 months, up to 51 months), 70 patients had recurrent AF, including 13 patients (6%) with very late (>12 months) recurrent AF (group 1) and 57 patients (28%) with late (within 12 months after ablation) recurrent AF (group 2). Group 1 patients had a significantly lower incidence of multiple (> or = 2) AF foci (23% vs 63%, P = 0.02) than group 2 patients. In addition, the incidence of antiarrhythmic drugs use (38% vs 84%, P = 0.001) to maintain sinus rhythm after the first episode of recurrent AF was significantly lower in group 1 than group 2 patients, and the incidence of a second intervention procedure (8% vs 35%, P = 0.051) tended to be lower in group 1 than group 2 patients. CONCLUSION: The incidence of very late recurrent AF after ablation of paroxysmal AF is very low, and the clinical outcome of patients with very late recurrent AF is benign.     

Demographic profile of patients undergoing catheter ablation of atrial fibrillation

Demographic Profile of Patients Undergoing AF Ablation. Background: Catheter ablation is a widely accepted treatment for drug refractory atrial fibrillation (AF). The purpose of our study was to examine secular trends in the demographic profile of patients undergoing AF ablation. Methods and Results: Data for 792 patients who underwent catheter ablation for AF at Johns Hopkins Hospital between years 2001 and 2009 were systematically reviewed. There has been a steady increase in total number of procedures and repeat procedures. The majority of patients undergoing AF ablation at our institution are men (76.6%). Females accounted for 36.0% of patients in 2001 versus 19.6% in 2009. A total of 93.3% of patients undergoing AF ablation were Caucasian. The mean age of patients has increased over time (52 years in 2001 to 60 years in 2009, P = 0.015) and the number of antiarrhythmic drugs (AADs) used prior to first ablation has decreased (2.3 to 1.2, P = 0.009). In addition, the mean duration of AF prior to first referral has decreased (7.8 years in 2001 vs 4.2 years in 2009). Conclusion: There is a significant gender and racial disparity in patients undergoing AF ablation favoring Caucasian men that warrants further investigation. We also observed a significant increase in age of patients, decrease in number of AADs, and increase in number of repeat procedures. These results are important when interpreting outcomes of AF ablation and designing future trials. (J Cardiovasc Electrophysiol, Vol. 22, pp. 994‐998, September 2011)     

Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION: Elimination of the initiating focus within the pulmonary vein (PV) using radiofrequency (RF) catheter ablation is a new treatment modality for treatment of drug-refractory atrial fibrillation. However, information on the long-term safety of RF ablation within the PV is limited. METHODS AND RESULTS: In 102 patients with drug-refractory atrial fibrillation and at least one initiating focus from the PV, series transesophageal echocardiography was performed to monitor the effect of RF ablation on the PV. There were 66 foci in the right upper PV and 65 foci in the left upper PV. Within 3 days of ablation, 26 of the ablated right upper PVs (39%) had increased peak Doppler flow velocity (mean 130+/-28 cm/sec, range 106 to 220), and 15 of the ablated left upper PVs (23%) had increased peak Doppler flow velocity (mean 140+/-39 cm/sec, range 105 to 219). Seven patients had increased peak Doppler flow velocity in both upper PVs. No factor (including age, sex, site of ablation, number of RF pulses, pulse duration, and temperature) could predict PV stenosis after RF ablation. Three patients with stenosis of both upper PVs experienced mild dyspnea on exertion, but only one had mild increase of pulmonary pressure. There was no significant change of peak and mean flow velocity and of PV diameter in sequential follow-up studies up to 16 (209+/-94 days) months. CONCLUSION: Focal PV stenosis is observed frequently after RF catheter ablation applied within the vein, but usually is without clinical significance. However, ablation within multiple PVs might cause pulmonary hypertension and should be considered a limiting factor in this procedure.     

心房颤动导管消融术后早期心力衰竭12例临床分析

目的:认识心房颤动(房颤)导管消融术的另一种并发症--急性心力衰竭(心衰).方法:回顾分析12例既往无心力衰竭史、因房颤经导管消融术后早期发生急性心衰患者的临床资料.结果:1 032例房颤导管消融术后48 h内发生急性心衰12例(1.2%),12例中慢性房颤11例,阵发性房颤1例.临床表现为呼吸急促12例(100%),其中端坐呼吸8例(67%),剧烈胸痛2例(17%),发热(37.5℃～38.5℃)6例(50%),肺部湿性啰音12例(100%),心室率增快12例(100%),低血压1例(8%),胸片提示胸腔积液3例(25%)、肺水肿改变4例(33%),经胸超声心动图提示少量心包积液5例(42%),白细胞计数大于10.0×109/L 7例(58%),左室射血分数(59.6±3.2)%.所有患者于治疗后2～7 d内临床症状消失.结论:房颤导管消融术后早期可能会发生心衰,合理的支持治疗可在短期内改善病情.     

Pulmonary vein stenosis complicating catheter ablation of focal atrial fibrillation

INTRODUCTION: A recently described focal origin of atrial fibrillation, mainly inside pulmonary veins, is creating new perspectives for radiofrequency catheter ablation. However, pulmonary venous stenosis may occur with uncertain clinical consequences. This report describes a veno-occlusive syndrome secondary to left pulmonary vein stenosis after radiofrequency catheter ablation. METHODS AND RESULTS: A 36-year-old man who experienced daily episodes of atrial fibrillation that was refractory to antiarrhythmic medication, including amiodarone, was enrolled in our focal atrial fibrillation radiofrequency catheter ablation protocol. The left superior pulmonary vein was the earliest site mapped, and radiofrequency ablation was performed. Atrial fibrillation was interrupted and sinus rhythm restored after one radiofrequency pulse inside the left superior pulmonary vein. Atrial fibrillation recurred and a new procedure was performed in an attempt to isolate (26 radiofrequency pulses around the ostium) the left superior pulmonary vein. Ten days later, the patient developed chest pain and hemoptysis related to severe left superior and inferior pulmonary veins stenosis. Balloon angioplasty of both veins was followed by complete relief of symptoms after 2 months of recurrent pulmonary symptoms. The patient has been asymptomatic for 12 months, without antiarrhythmic drugs. CONCLUSION: Multiple radiofrequency pulses applied inside the pulmonary veins ostia can induce severe pulmonary venous stenosis and veno-occlusive pulmonary syndrome.     

EnSite NavX指导下无肺静脉造影的阵发性心房颤动导管消融术

目的探讨不作肺静脉造影行阵发性心房颤动(房颤)环肺静脉电隔离术的有效性和可行性。方法 34例阵发性房颤患者分为无肺静脉造影组(n=18)和肺静脉造影组(n=16),无肺静脉造影组不作肺静脉造影,余步骤与肺静脉造影组相同,两组均在EnSiteNavX三维标测系统指导下重建左心房及肺静脉,再分别行左、右环肺静脉电隔离术,消融终点为肺静脉与心房完全电隔离。结果无肺静脉造影组消融术时间[(92.78±19.46)minvs.(106.44±20.18)min,P0.05]及X-线曝光时间[(11.47±4.32)minvs.(16.06±8.72)min,P0.05]少于肺静脉造影组,差异有统计学意义。两组左心房三维重建时间[(6.22±2.65)minvs.(6.31±3.00)min,P0.05]、左、右侧环肺静脉消融时间[(21.61±7.66)minvs.(20.50±8.09)min,P0.05;(17.33±10.22)minvs.(17.48±7.86)min,P0.05]及即刻消融成功率[100%(18/18)vs.100%(16/16),P0.05]比较,差异无统计学意义。结论不作肺静脉造影,仅在三维标测系统指导下行房颤消融治疗,可达到相同消融效果,可节省消融术及X-线曝光时间,减少手术步骤、耗材和费用。     

Impact of catheter ablation of the coronary sinus on paroxysmal or persistent atrial fibrillation

Objectives: This study evaluated the impact of catheter ablation of the coronary sinus (CS) region during paroxysmal and persistent atrial fibrillation (AF).
Background: The CS musculature and connections have been implicated in the genesis of atrial arrhythmias.
Methods: Forty-five patients undergoing catheter ablation of AF were studied. The CS was targeted if AF persisted after ablation of pulmonary veins and selected left atrial tissue. CS ablation was commenced endocardially by dragging along the inferior paramitral left atrium. Ablation was continued from within the vessel (epicardial) if CS electrograms had cycle lengths shorter than that of the left atrial appendage.
RF energy was limited to 35 W endocardially and 25 W epicardially. The impact of ablation was evaluated on CS electrogram cycle length (CSCL) and activation sequence, atrial fibrillatory cycle length measured in the left atrial appendage (AFCL) and on perpetuation of AF.
Results: Endocardial ablation significantly prolonged CSCL by 17 ± 5 msec and organized the CS activation sequence (from 13% of patients before to 51% after ablation); subsequent epicardial ablation further increased local CSCL by 32 ± 27 msec (P < 0.001). AFCL prolonged significantly both during endocardial and epicardial ablation (median: 152 to 167 msec P = 0.03) and was associated with AF termination in 16 (35%) patients (46% of paroxysmal and 30% of persistent AF). AFCL prolongation ≥5 msec and/or AF termination was associated with more rapid activity in the CS region originally: P ≤ 0.04.
Conclusion: Catheter ablation targeting both the endocardial and epicardial aspects of the CS region significantly prolongs fibrillatory cycle length and terminates AF persisting after PV isolation in 35% of patients.     

峡部依赖性心房扑动对心房颤动发作的影响

目的观察导管射频消融治疗峡部依赖性心房扑动(房扑)对心房颤动(房颤)发作的影响,进一步探讨房扑和房颤的关系。方法86例房扑患者,其体表心电图均提示典型房扑,男性54例、女性32例,年龄50.0±15.6(11～74)岁,病程5.6±6.4(0.1～30)年。将所有患者分成A、B两组,A组为房扑合并房颤患者,共25例;B组为不合并房颤患者,共61例;其中A组同时合并房室结折返性心动过速(AVNRT)3例,房室折返性心动过速(AVRT)4例,阵发性房性心动过速(PAT)10例;B组合并房室结折返性心动过速5例,房室折返性心动过速7例。对峡部依赖性房扑者,线性消融下腔静脉—三尖瓣环峡部致双向传导阻滞;房室折返性心动过速者行旁道消融术;房室结折返性心动过速者行慢径改良术,阵发性房速术中持续或可诱发,予以射频消融。平均随访27.1±14.1(6～63)月。结果A组25例患者中,术后68%(17/25)患者不再发作房颤;其余8例仍有房颤发作,其中1例为术前同时合并房室折返性心动过速,5例为合并阵发性房速。61例术前不合并房颤者,术后随访中有16.4%(10/61)新发房颤。86例患者中,6例因病态窦房结综合征行起搏器植入术,随访未诉心悸、胸闷,心电图为窦性心律与起搏心律交替出现。结论房扑可能与房颤具有共同的发生基质,也可以是房颤的触发因素,成功消融房扑后可以阻止房颤的发生。但房颤发生机制多样,消融峡部依赖性房扑,仍会发生房颤,术前合并房颤或房速者是最强的预测因子。     

心房颤动射频消融术后复发危险因素的研究进展

心房颤动（房颤）是临床最常见的心律失常类型之一,给患者和社会带来沉重的生活和经济负担。尽管目前射频消融术已经成为房颤的重要治疗手段,但术后复发一直是医生面临的难题,也成为研究者关注的热点。本文总结了国内外有关房颤射频消融术后复发危险因素的最新研究进展。     

环肺静脉与复合消融治疗阵发性心房颤动的远期疗效

目的比较环肺静脉消融和复合消融治疗阵发性心房颤动(paroxysmal atrial fibrillation,PAF)后长期随访的成功率,探讨导管消融治疗PAF的路线和终点。方法选择2006年1月至2007年8月接受导管消融治疗的PAF患者141例,分为两组。第1组:单纯环肺静脉消融,在三维心脏电解剖标测系统(CARTO系统)和单环状标测电极(LASSO电极)指导下行同侧环肺静脉左心房线性消融至左心房-肺静脉电活动双向传导阻滞;第2组:复合消融,即在环肺静脉消融后,常规进行心房高频刺激,根据术中是否有自发或诱发的房性心律失常而选择右心房峡部、左心房峡部、左心房顶部、冠状窦左心房心内膜面、左心耳部、碎裂电位、冠状静脉窦内消融或上腔静脉隔离等附加消融方式。比较两组的消融结果和并发症发生情况。结果第1组消融过程中6例出现自发的持续房性心动过速(auricular tachycardia,AT)转为复合消融。结果按照实际治疗原则进行分析,即第1组64例,第2组77例。两组性别、年龄、病程、左心房内径、左心室射血分数及手术时间比较,差异无统计学意义(P0.05)。第2组X-线曝光时间较第1组显著增加,差异有统计学意义[(39.8±14.2)min vs.(33.1±10.7)min,P=0.002]。随访(39.2±5.2)个月,两组单次消融术后房性心律失常复发率比较,差异无统计学意义[23.4%(15/64)vs.26.0%(20/77),P=0.729]。第1组5例AT和4例PAF接受重复消融,其中5例AT及2例PAF治疗成功;第2组6例AT和6例PAF接受重复消融,其中5例AT和3例PAF治疗成功。两组两次或三次消融后总的窦性心律维持率比较,差异无统计学意义[87.5%(56/64)vs.84.4%(65/77),P=0.603)。结论导管消融治疗PAF的远期成功率高;环肺静脉消融与复合消融治疗PAF的远期效果相似,但X-线曝光时间相对较短,损伤较小;对于复发的患者,寻找肺静脉以外的靶点可进一步提高导管消融治疗PAF的成功率。     

经导管环肺静脉左房线性消融术对阵发性心房颤动患者左心房结构和功能的影响

目的: 评价环肺静脉左房线性消融术对阵发性心房颤动（房颤）患者左心房结构和功能的影响。方法: 阵发性房颤患者33例,Carto系统下行环肺静脉左房线性消融术,应用超声心动图测定其消融术前1～3 d、术后1、3、6、12个月静息时窦性心律下左心房内径、容积指标、二尖瓣口A波速度峰值(VA)及E波速度峰值(VE),并计算左心房排空分数,分析消融术前后左心房结构和功能的变化。结果: 33例阵发性房颤患者均成功施行环肺静脉左房线性消融术,1年治愈率82%。左房前后径消融术后1个月较术前显著增大［(44±4)mm vs. （41±3）mm,P<0.01］,术后3个月、6个月时与术前比较无显著差异,随访1年时左房前后径较术前有显著减小［（40±3）mm vs. (41±3)mm,P<0.05］。与左心房辅助泵功能相关的左心房最小容积,术后1个月显著增大,左心房主动排空分数、左心房总排空分数显著降低（P<0.05),术后3个月时恢复到术前水平。VA术后均低于术前（P<0.05,P<0.01）,而VE/VA术后1个月显著上升（P<0.05,P<0.01）,但在随后的随访中与术前无显著差异。 结论: 阵发性房颤患者左房环肺静脉线性消融术后近期左房前后径增大,辅助泵功能下降,术后3个月恢复至术前水平,术后1年左房结构可部分逆重构。     

Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers

INTRODUCTION: Ablative therapy for atrial fibrillation (AF) by targeting initiating triggers, usually in or around the pulmonary veins, has been reported by several centers. Evidence for an overall improvement in quality of life (QOL) and amelioration of symptoms is lacking. METHODS AND RESULTS: Seventy-one patients undergoing attempted ablation of focal AF were followed for 60+/-33 weeks. QOL and symptom questionnaires were completed 1 month before and 6 months after electrophysiologic study. Twenty-three patients (32%) underwent electrophysiologic mapping but no ablation because of either insufficient or multifocal ectopy; the other 48 patients (68%) underwent attempted ablation. Sixteen of 48 patients (33%) undergoing ablation, or 16 (23%) of 71 on an intention-to-treat basis, were found at last follow-up to have persistent sinus rhythm without antiarrhythmic drugs. Patients who underwent mapping without ablation reported no improvements in any QOL or symptom score, whereas patients who had long-term successful ablation had significant improvements in all six QOL measures. Interestingly, patients who developed AF recurrence after ablation still reported significant improvements in 4 of 6 QOL measures. Four of 48 patients (8.3%) undergoing ablation developed pulmonary vein stenosis. CONCLUSION: Paroxysmal AF can be treated successfully in some patients by ablating initiating triggers in the pulmonary veins; however, in our experience the recurrence rate (32/48 [68%]) and risk of pulmonary vein stenosis (8%) after ablation are high. Patients with recurrent AF after ablation of focal AF triggers have significant improvement in QOL and symptoms compared with before ablation. Patients and their physicians should carefully balance the risks and benefits before considering ablation.     

三尖瓣峡部消融对心房颤动导管消融术后复发的影响

目的:评估三尖瓣峡部消融对伴有典型心房扑动(房扑)和不伴典型房扑发作的心房颤动(房颤)患者术后复发的影响.方法:连续入选房颤射频消融治疗患者113例,根据有无典型房扑分为三尖瓣峡部消融组(CTI组)和未行三尖瓣峡部消融组(Non-CTI组),比较临床特征及手术特点,并随访术后典型房扑和房颤发生率.结果:Non-CTI组左房内径更大,持续性和永久性房颤的比例、左房线性消融的比例更高.而CTI组射频消融时间较Non-CTI组更长.术后典型房扑和房颤发生率2组无显著区别.结论:无典型房扑发作的房颤患者,不行三尖瓣峡部消融,不会升高术后典型房扑发生率和房颤复发率,同时射频消融时间缩短.     

The history of atrial fibrillation: the last 100 years

Atrial fibrillation (AF) has had a rich history that has touched the careers of many of the great clinicians and investigators of the 20th century. More recently, there has been an explosion of research into various aspects of the mechanisms and therapy for AF, as evidenced by over 8,000 publications on AF from 2000 to 2007. A century of research and clinical observations, coupled with modern investigative technologies, has enabled modern investigators to have their own "fantastic voyage" as they travel beyond the cell borders into the ionic mechanisms responsible for AF and its many atrial perturbations. One can only imagine the satisfaction of Wenckebach, MacKenzie, and Lewis if they could see how their seeds of wisdom have grown into such sturdy ideas, or how delighted Scherf would be to learn that his ectopic focus theory for AF has been given new life.
This paper on 100 years of AF was initially prepared for presentation as the Plenary Lecture at the AFib Summit for Heart Rhythm 2007 in Denver, Colorado. I have tried to provide the reader with some of the most important observations on AF, realizing that it would be impossible to include all or even most of the major research done during this time frame. I apologize to my many colleagues whose research has helped us to understand better the clinical and basic aspects of AF, yet who could not be cited for lack of space.     

Robotic navigation in catheter ablation for paroxysmal atrial fibrillation: midterm efficacy and predictors of postablation arrhythmia recurrences

Robotic Navigation in Ablation of Paroxysmal AF . Introduction: Remote navigation systems represent a novel strategy for catheter ablation of atrial fibrillation (AF). The goal of this study is to describe a single‐center experience with the electromechanical robotic system (Sensei, Hansen Medical) in treatment of patients with paroxysmal AF. Methods: Out of 200 patients who underwent robotically guided ablation for AF between 2007 and 2009 at our institute, 100 patients (29 women, age 56.5 ± 10 years) had paroxysmal AF refractory to antiarrhythmic drugs. Electroanatomic mapping using NavX system (St. Jude Medical) provided anatomical shell for subsequent circumferential ablation with robotic catheter (Artisan) loaded with a 3.5‐mm, open‐irrigation, cooled‐tip ablation catheter. Results: A mean of 69 radiofrequency current applications (duration 2082 ± 812 seconds) were delivered to achieve circumferential electrical isolation of pulmonary venous antra. Total procedural time reached 222 ± 54 minutes. The mean fluoroscopic time was 11.9 ± 7.8 minutes. There were no major procedure‐related complications. After a median follow‐up of 15 months (range 3‐28 months), 63% of the patients were free from any atrial arrhythmias ≥ 30 seconds after the single procedure. Success rate increased to 86% after 1.2 procedures. Multivariate analysis revealed that only predictor of recurrent AF/AT was shorter overall procedural time (207 ± 36 vs 236 ± 64 minutes in patients with and without recurrences, respectively, P = 0.0068). Conclusions: This study demonstrates feasibility and safety of robotic navigation in catheter ablation for paroxysmal AF. Midterm follow‐up documents success rate comparable to other technologies and potential for improvement in more extensive ablation along the ridges with thicker myocardium. (J Cardiovasc Electrophysiol, Vol. 22, pp. 534‐540 May 2011)     

阵发性心房颤动的射频导管消融大静脉电隔离治疗

目的报道阵发性心房颤动(房颤)的射频导管消融电隔离肺静脉和腔静脉的疗效。方法阵发性房颤患者36例,年龄(42.5±13.2)岁。经1次房间隔穿刺放置环状标测电极导管(Lasso导管)和冷盐水灌注消融导管,在Lasso导管的指导下,采用全肺静脉或上腔静脉与靶静脉节段性电隔离相结合的方法对肺静脉和腔静脉行标测和电隔离治疗。窦性心律时最早激动的肺静脉和腔静脉电位处和/或心房起搏时最短的心房和静脉电位间期处为靶点行消融。结果36例阵发性房颤患者均接受一次电隔离治疗,共电隔离大静脉115根,其中左上肺静脉34根,左下肺静脉22根,右上肺静脉30根,右下肺静脉17根,上腔静脉12根,即刻电隔离成功率为95.6%,术中并发症发生率2.78%。随访3~22个月,成功率(无房颤发作或房颤发作明显减少)为75.0%。结论射频导管消融电隔离肺静脉或腔静脉与心房间的电活动连接,可有效预防房颤的复发。治疗的关键是消融靶点的标测和确定。     

Catheter ablation of atrial fibrillation

Following the advent of the surgical maze procedure, several catheter techniques have been developed to provide permanent prophylaxis against atrial fibrillation. These noninvasive techniques work by compartmentalizing the atria, by ablating the arrhythmogenic foci, or by isolating the atria from these foci. Although still at an early stage of development, preliminary results using focal ablation and circumferential ablation show extreme promise.     

Complications of catheter ablation for atrial fibrillation: incidence and predictors

Introduction: Pulmonary vein (PV) isolation by catheter ablation is an increasingly used strategy to treat atrial fibrillation (AF). Complication rates from AF ablation reported in different case series vary widely. We conducted a retrospective analysis of 641 consecutive ablation procedures to assess complication rates, temporal trends, and clinical predictors of adverse outcomes.
Methods: All patients (n = 517) undergoing catheter ablation for AF at Johns Hopkins Hospital between February, 2001 and June, 2007 were prospectively enrolled in a database. Data from 641 consecutive procedures were analyzed and complications considered if they occurred within 30 days of ablation. Major complications were defined as those that required intervention, resulted in long-term disability, or prolonged hospitalization.
Results: Thirty-two major complications occurred in 641 procedures (5%). Among the patients with major complications, seven had cerebrovascular accident (CVA), eight had tamponade, one had PV occlusion with hemoptysis, and 11 had vascular injury requiring surgical repair and/or transfusion. No periprocedural deaths occurred, and no instances of esophageal injury were seen. Complication rates were higher during the first 100 cases (9.0%) than during the subsequent 541 (4.3%). Major adverse clinical events were associated with age > 70 years (P = 0.007; odds ratio 3.7, 95% confidence interval 1.4–9.6) and female gender (P = 0.014; odds ratio 3.0, 95% confidence interval 1.3–7.2). No other clinical or procedural predictors of complication were identified.
Conclusions: Complication rates from AF ablation remain significant, despite improved techniques and increased awareness of procedural risks. Both advanced age and female gender predict major adverse events, suggesting careful consideration of the risk/benefit profile in these patients prior to ablation.     

Early recurrences after atrial fibrillation ablation: prognostic value and effect of early reablation

Introduction: Early arrhythmia recurrences are common within the first month after atrial fibrillation (AF) ablation. The long-term consequences of these early recurrences (ER) are controversial. We investigated whether ER were predictive of late recurrences and the impact of early reablation on clinical outcome.
Methods: Three hundred two consecutive patients with paroxysmal or persistent AF were studied. Arrhythmia recurrence was defined as documented episode of AF or atrial tachycardia. Of 151 patients with ER, a subset of 61 patients had reablation within the first month following the index ablation (early reablation). In the remaining 90 patients, a repeat procedure was only performed for later arrhythmia recurrences occurring beyond 1 month. Patients were followed with clinical interview and ambulatory 24 hours monitoring.
Results: Patients with and without early reablation had similar baseline characteristics including echocardiographic parameters and type of AF. During a mean follow-up of 11 ± 11 months, 82 patients (91%) without early reablation experienced late clinical recurrences. In contrast, patients with early reablation had lower rate of clinical recurrences (51% vs 91%, P < 0.0001) and fewer additional procedures (36% vs 91%, P < 0.0001). However, the total number of procedures over the entire follow-up was greater in those patients with early reablation (2.5 ± 0.7 vs 2.2 ± 0.6, P = 0.02).
Conclusion: An overwhelming majority of patients with recurrences within the first month after ablation have late recurrences. An early reablation reduces the incidence of further recurrences. However, the overall number of procedures is higher in the medium-term follow-up. The optimal timing for the second procedure remains to be defined.