Atrial fibrillation patients with isolated pulmonary veins: Is sinus rhythm achievable?

Autor:	Jeffrey E. Olgin, Edward P. Gerstenfeld, Byron K. Lee, Gregory M. Marcus, Randall J. Lee, Tomos E. Walters, Nitish Badhwar, Vasanth Vedantham, Zian H. Tseng, Judit Szilagyi, Melvin M. Scheinman
Rok vydání:	2017
Předmět:	medicine.medical_specialty business.industry medicine.medical_treatment Cardiomyopathy Atrial fibrillation Catheter ablation 030204 cardiovascular system & hematology medicine.disease Ablation 03 medical and health sciences 0302 clinical medicine Physiology (medical) Internal medicine cardiovascular system medicine Cardiology Sinus rhythm In patient 030212 general & internal medicine Cardiology and Cardiovascular Medicine Atrial substrate business Atrial flutter
Zdroj:	Journal of Cardiovascular Electrophysiology. 28:754-761
ISSN:	1045-3873
DOI:	10.1111/jce.13230
Popis:	Background: The cornerstone of atrial fibrillation (AF) ablation is isolation of the pulmonary veins (PVs). Patients with recurrent AF undergoing repeat ablation usually have PV reconnection (PVr). The ablation strategy and outcome of patients undergoing repeat ablation who have persistent isolation of all PVs (PVi) at the time of repeat ablation is unknown.Methods and results: We studied consecutive patients with recurrent AF undergoing repeat ablation and compared patients with PVi to those with PVr. One hundred fifty-two patients underwent repeat ablation, and of these, 25 patients (16.4%) had PVi. Patients with PVi underwent ablation targeting any isoproterenol induced AF triggers, atrial substrate, or inducible atrial tachycardias or flutters. Patients with PVi compared to PVr were more likely to have a history of persistent AF (64% vs. 26%; P < 0.0001), obesity (BMI 30.4 vs. 28.2; P = 0.05), and prior use of contact force sensing catheters (28% vs. 0.8%, P < 0.0001). After a mean follow-up of 19 +/- 15 months, 56% of PVi patients remained in sinus rhythm compared to 76.3% of PVr patients (P = 0.036). In a multi-variable model, PVi patients and those with cardiomyopathy had a higher risk of recurrent atrial tachyarrhythmias (HR = 3.6 95%, CI 1.6-8.3, P = 0.002 and HR = 6.2, 95% CI 2.3-16.3, P < 0.0001, respectively).Conclusion: In patients who have all PVs isolated at the time of the redo AF ablation, a strategy of targeting non-PV AF triggers and inducible flutters can still lead to AF freedom in more than half of patients. Patients with PVr, however, have a better long-term outcome.
Databáze:	OpenAIRE
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