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- Title
Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations.
- Authors
Mohanty, Sanghamitra; Trivedi, Chintan; Gianni, Carola; Della Rocca, Domenico Giovanni; Morris, Eli Hamilton; Burkhardt, J. David; Sanchez, Javier E.; Horton, Rodney; Gallinghouse, G. Joseph; Hongo, Richard; Beheiry, Salwa; Al-Ahmad, Amin; Di Biase, Luigi; Natale, Andrea
- Abstract
Introduction This study reports the procedural findings and ablation outcome in AF patients referred after ≥2 failed PV isolation (PVI). Methods Three hundred and five consecutive AF patients referred after ≥2 PVI were included in the analysis. High-dose isoproterenol challenge was used to identify PV reconnection and non-PV triggers; the latter were ablated based on the operator's discretion during the index procedure. At the repeat procedure, non-PV triggers were ablated in all. Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non-PV triggers were detected. Results PV reconnection was detected in 226 and non-PV triggers were identified or empirically isolated in 285 patients during the index procedure. At follow-up, 182 (60%) patients were recurrence-free off-AAD; the success rate with and without non-PV ablation was 81% vs. 8% (P < 0.0001). 104 patients underwent repeat procedure with non-PV trigger ablation in all. At 1 year, 90% were arrhythmia free off-AAD in non-PV ablation group, and 72% who did not receive non-PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5% and 82% after the index and repeat procedure, respectively. Conclusion In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non-PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non-PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia-free survival.
- Subjects
ARRHYTHMIA; ATRIAL fibrillation; CATHETER ablation; ISOPROTERENOL; EMPIRICAL research
- Publication
Journal of Cardiovascular Electrophysiology, 2017, Vol 28, Issue 12, p1379
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.13329