Sultan, Arian; Lüker, Jakob; Hoffmann, Boris; Servatius, Helge Simon; Schäffer, Benjamin; Steven, Daniel; Willems, Stephan (2015). Interventional management of recurrent paroxysmal atrial fibrillation despite isolated pulmonary veins: impact of an ablation strategy targeting inducible atrial tachyarrhythmias. Europace, 18(7), euv332. Oxford University Press 10.1093/europace/euv332
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AIMS
Pulmonary vein isolation (PVI) is an effective treatment option for paroxysmal atrial fibrillation (PAF). Reconnection of pulmonary veins (PVs) is the predominant cause for recurrence of PAF. However, treatment of patients with recurrence of PAF despite isolated PV in the absence of extra-PV foci remains challenging.
METHODS AND RESULTS
Of 265 patients undergoing repeat catheter ablation (CA) for recurrence of PAF 21 (8%) patients (14 men, age 58 ± 14 years) showed no reconnection of PV. Therefore, inducibility of sustained atrial arrhythmias was tested. If sustained atrial fibrillation (AF) or sustained atrial tachycardia (AT) was induced, patients underwent CA. During follow-up (FU), Holter- and Tele-electrocardiogram were performed. In 19 (91%) of 21 patients, sustained atrial arrhythmias [16 (84%) AF; 3 (15%) patients AT] were induced. One patient showed PAF. Eighteen patients underwent CA aiming for termination of induced arrhythmia. In 14 (77%) patients, termination into sinus rhythm was achieved. Despite extensive CA, three (16%) patients were externally cardioverted. No periprocedural complications occurred. During 21.2 ± 6.8-month FU, 10 (53%) patients were free of any arrhythmia. Paroxysmal atrial fibrillation recurred in 4 (21%) and AT in 5 (26%) patients. One patient showed persistent AF. Repeat CA was scheduled and successfully performed for these patients.
CONCLUSION
In patients with recurrence of PAF despite isolated PV, termination of induced atrial arrhythmias can be achieved in most patients by defragmentation and AT ablation. Moreover, this ablation strategy results in favourable mid-term outcome results.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Servatius, Helge Simon (A) |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1099-5129 |
Publisher: |
Oxford University Press |
Language: |
English |
Submitter: |
Helge Simon Servatius |
Date Deposited: |
16 Feb 2016 16:22 |
Last Modified: |
29 Mar 2023 23:34 |
Publisher DOI: |
10.1093/europace/euv332 |
PubMed ID: |
26462703 |
Uncontrolled Keywords: |
Ablation; Inducible atrial tachyarrhytmias; Paroxysmal atrial fibrillation; Pulmonary vein isolation |
BORIS DOI: |
10.7892/boris.75446 |
URI: |
https://boris.unibe.ch/id/eprint/75446 |
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