Recurrent atrial arrhythmias in the setting of chronic pulmonary vein isolation

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• 作者：Mouhannad M. Sadek ; MD ; FHRS<sup>*sup> ; Shingo Maeda ; MD ; PhD<sup>&dagger ; sup> ; William Chik ; MBBS ; PhD<sup>&dagger ; sup> ; Pasquale Santangeli ; MD ; PhD<sup>&dagger ; sup> ; Erica S. Zado ; PA-C ; FHRS<sup>&dagger ; sup> ; Robert D. Schaller ; DO ; FHRS<sup>&dagger ; sup> ; Gregory E. Supple ; MD ; FHRS<sup>&dagger ; sup> ; David S. Frankel ; MD ; FHRS<sup>&dagger ; sup> ; Mathew D. Hutchinson ; MD ; FHRS<sup>&dagger ; sup> ; Fermin C. Garcia ; MD<sup>&dagger ; sup> ; Michael P. Riley ; MD ; PhD<sup>&dagger ; sup> ; David Lin ; MD ; FHRS<sup>&dagger ; sup> ; Sanjay Dixit ; MD ; FHRS<sup>&dagger ; sup> ; David J. Callans ; MD ; FHRS<sup>&dagger ; sup> ; Francis E. Marchlinski ; MD ; FHRS<sup>&dagger ; sup><sup> ; sup><sup>Francis.Marchlinski@uphs.upenn.edu" class="auth_mail" title="E-mail the corresponding authorsup>
• 关键词：Atrial fibrillation ablation ; Pulmonary vein isolation ; Triggers ; Complex fractionated atrial electrogram ; Catheter ablation
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：13
• 期：11
• 页码：2174-2180
• 全文大小：1014 K

文摘

Atrial arrhythmias may still occur in patients after durable pulmonary vein isolation (PVI).p>

sSec_2">Objective

<p id="sp0040">The purpose of this study was to examine the incidence of patients undergoing ablation for recurrent arrhythmia despite chronic PVI and their clinical outcomes.p>

sSec_3">Methods

<p id="sp0045">Patients undergoing repeat left atrial ablation procedures were selected from a prospective registry. From this population, we identified patients with chronic PVI. Clinical characteristics, ablation strategies, and outcomes were analyzed.p>

sSec_4">Results

<p id="sp0050">Between January 2003 and December 2013, 1045 patients underwent 1298 repeat left atrial procedures. Of these, 900 patients had atrial fibrillation (AF) and 145 had atrial flutter (AFL)/atrial tachycardia (AT). Fifty-two patients (5.0%; 27 with AF and 25 with AFL/AT) had chronic PVI and were included in the study. Patients were followed for 19.7 &plusmn; 5.6 months. In patients with AF, 11 (41%) had a non-PV trigger identified. Ablation strategies included non-PV trigger ablation (n = 11), empiric trigger-site ablation (n = 3), provoked arrhythmia ablation (n = 9), complex fractionated atrial electrogram ablation (n = 2), and linear ablation (n = 2). During follow-up, 9 (33%) had no recurrence, 7 (26%) had rare AF (≤2 episodes during follow-up ≥1 year), and 11 (41%) had AF recurrence. In patients with AFL/AT, 12 (48%) had no recurrence, 4 (16%) had rare recurrence (≤2 episodes during follow-up ≥1 year), and 9 (36%) had recurrence.p>

sSec_5">Conclusion

<p id="sp0055">In patients with PVI undergoing a repeat procedure during the time period studied, only a small portion had chronic PVI. A strategy of targeting non-PV triggers for AF and linear/focal ablation for AFL/AT may achieve long-term arrhythmia control in the majority of patients.