Abstract 2316: Very Late Recurrences of Atrial Fibrillation Following Pulmonary Vein Isolation: Outcomes Following Repeat Pulmonary Vein isolation
Introduction: Pulmonary vein isolation (PVI) is increasingly used to treat atrial fibrillation (AF). Although long-term cure would be ideal, as it is for most other SVTs, very late recurrences (VLR) of AF are being increasingly recognized despite initial and prolonged success post-PVI. We sought to determine the incidence of VLR; the observations at re-ablation; and the efficacy of re-ablation in these pts.
Methods: We prospectively followed 341 pts (72% M, 57±11 yrs, 83% paroxysmal AF) who were AF-free ≥1 year on no antiarrhythmic drugs (AADs) following PVI. During a median follow-up of 3 years, 33 (9.7 %) pts had recurrence of AF at 35±20 mos post-PVI (Figure⇓). Most of these pts had recurrent and symptomatic AF; 26 of these 33 (78%) pts underwent repeat ablation. Complete response (CR) was defined as absence of AF off AADs at 6 mos post repeat ablation.
Results: All 26 (100%) pts had PV-LA reconnection. These involved 2.5±0.9 PVs per pt; 8.2±5.6 lesions per pt were required to re-isolate all PVs. In 10 (38%) pts, additional linear lesions (LA roof in 90%, mitral isthmus in 100%, CS in 3%) were applied empirically. The number of PVs reconnected (2.5±0.9 vs. 2.6±1.1; p=0.5) and number of lesions applied during repeat procedure (8.4±6.1 vs. 7.7±5.0; p=0.7) was similar in pts who did or did not undergo linear lesions. At 9.6±3.4 mos post-repeat procedure, all 26 pts had a CR.
Conclusion: VLR of AF after apparent “cure” post initial PVI are not uncommon. Similar to pts with early recurrence, the vast majority of these pts have PV-LA reconnections. At re-ablation, a strategy incorporating repeat PVI was very effective. The role of linear lesions in this pt population needs to be better defined.