Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Quality Measures & Complications D-PO05 - Poster Session V (ID 39) Poster

D-PO05-144 - Recurrence Of Atrial Fibrillation After Redo Catheter Ablation: Implications Of Non-pulmonary Vein Triggers (ID 1278)


Background: Pulmonary venous (PV) electrical recovery underlies most arrhythmia recurrences after atrial fibrillation (AF) ablation. Little is known about optimal ablation strategies in patients with recurrent AF despite electrically silent non-reconnected PVs.
Objective: to compare procedural profiles and outcomes of patients with or without electrically reconnected PVs upon redo ablation for AF.
Methods: We included 838 consecutive patients (2013-2016) undergoing redo AF ablation.Ablation targets: PV isolation and antral extension (as needed), posterior wall and septal to right PVs. Isoproterenol infusion was used in patients with silent PVs. Additional ablation was up to the operator.
Results: Most patients undergoing redo AF ablation (n=684, 82%) had PV reconnection while the remaining 154 (18%) had electrically silent PVs (Table 1). Patients with recurrent AF and electrically silent PVs were older and more likely to have non-paroxysmal AF. In addition to confirming isolation of the PVs with antral extension, patients underwent ablation of the posterior wall and septal to the right PVs. Additional non-PV ablations are outlined in Table 1. Upon one year of follow-up, patients with electrically silent PVs were more likely to experience AF recurrence (49% vs 31%, p=0.0001)
Conclusion: In patients with recurrent AF and electrically silent PVs, an ablation strategy targeting antral extension of ablation sets, ablation of posterior wall and septal to the right PVs in addition to non-PV ablations, allowed rhythm control in half of those patients. This remains a challenging group of patients, highlighting the need to better understand non-PV mediated AF.