Abstract 14388: Outcomes After Empirical Left Atrial Appendage Isolation in Patients With Very Late Atrial Tachyarrhythmia Recurrence, Persistent Pulmonary Vein Isolation, and No Evidence of Non-Pulmonary Vein Triggers
Introduction: Achieving permanent pulmonary vein antrum isolation (PVAI) is considered the main goal of catheter-based therapies for paroxysmal atrial fibrillation (AF). Whether permanent PVAI translates in a permanent cure in all patients with paroxysmal AF is still unclear. We report the prevalence of very late AF recurrences following permanent PVAI without any evidence of non-PV triggers, and the outcomes of empirical isolation of the left atrial appendage (LAA) in this subset of patients.
Methods: Out of 487 patients with paroxysmal AF who remained free from arrhythmia recurrence 2 years after a single PVAI procedure, a total of 63 (13%) experienced very late recurrence (average 5 years after the index procedure, range 2 to 11 years) and had no evidence of PV reconnection or non-PV triggers after high-dose isoproterenol challenge (20-30 μg/min for 15-20 minutes) at the repeat procedure.
Results: The mode of recurrence included atypical atrial flutter (27/63, 43%), persistent AF (21/63, 33%), and paroxysmal AF (15/63, 24%). Overall, 31 (49%) patients presented in the electrophysiology laboratory in persistent atrial arrhythmia (23 with AF and 8 with atypical atrial flutter). All the 8 atrial flutters were mapped in the LAA, and terminated with LAA isolation. In the remaining patients, the LAA was isolated empirically. After a mean follow-up of 19 ± 4 months, freedom from recurrent arrhythmia achieved 92%. The 5 patients who had recurrent arrhythmia (all with atypical atrial flutter) underwent a third procedure. All these patients had evidence of LAA reconnection, and the flutter was successfully terminated with LAA re-isolation.
Conclusions: Very late (≥2 years) arrhythmia recurrence in the presence of permanent PV antrum isolation and no evidence of non-PV triggers at high-dose isoproterenol challenge occurs in 13% of patients with paroxysmal AF. In these cases, empirical LAA isolation might be beneficial.
- © 2013 by American Heart Association, Inc.