Journal
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
Volume 26, Issue 10, Pages 1048-1056Publisher
WILEY
DOI: 10.1111/jce.12748
Keywords
atrial fibrillation; catheter ablation; nonpulmonary vein ectopy; pulmonary vein isolation; recurrence
Categories
Funding
- Taipei Veterans General Hospital [V101B-010, V102B-002, V102E7-003, V103C-042, V103C-126, V103E7-002, VGHUST103-G1-3-1]
- Ministry of Science and Technology [NSC100-2314-B-075-054-MY3, NSC 101-2911-I-008-001, NSC102-2325-B-010-005, MOST 103-2314-B-075-062-MY3]
- Research Foundation of Cardiovascular Medicine [RFCM 100-02-011, 101-01-001]
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Characteristics of Multiple AF Ablation Procedures BackgroundThe recurrence of atrial fibrillation (AF) is not uncommon in the era of catheter ablation. This study aimed to evaluate the characteristics of AF patients who underwent multiple (>2) ablation procedures. Methods and ResultsOf 666 consecutive patients (53 11 y/o, 484 men) who underwent catheter ablation of AF (paroxysmal AF, n = 530), 144 (22%) underwent 2 procedures and 52 (8%) underwent more than 2 procedures due to symptomatic recurrences refractory to medication during 48 +/- 23 months of follow-up. Baseline and procedural characteristics at the index procedure were investigated to determine their impact on the necessity of multiple procedures. After 2 procedures, 48 (92%) of 52 patients had pulmonary vein (PV) ectopic beats initiating AF. Coexisting PV and non-PV triggers were found in 23 of 48 patients. In a multivariate analysis, the presence of non-PV triggers (P = 0.004; odds ratio 2.69, 95% CI 1.37-5.28) at the index procedure was the only independent predictor of necessary multiple procedures. Among patients with non-PV ectopic beats initiating AF at the index procedure, the presence of ligament of Marshall triggers (P = 0.001, odds ratio 6.74, 95% CI 2.13-21.32) could predict the necessity of multiple procedures. ConclusionsThe need for multiple catheter ablation procedures can be predicted by the presence of non-PV ectopic beats initiating AF at the index procedure. However, PV-initiated AF remains the major cause of AF recurrence despite multiple catheter ablation procedures.
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