Atrial Tachycardias Following Persistent Atrial Fibrillation Ablation: Predictors of Recurrence After the Repeat Ablation

Ammar-Busch, Sonia; Kaess, Bernhard M.; Bruhm, Alexandra; Reents, Tilko; Bourier, Félix; Buiatti, Alessandra; Semmler, Verena; Telishevska, Marta; Kottmaier, Marc; Hessling, Gabriele; Deisenhofer, Isabel

doi:10.1111/jce.12817

Cited by 9 publications

(12 citation statements)

References 30 publications

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“…Furthermore, short-term complication or long-term MACE, MACCE, or composite safety were not different between repeat and index ablation. In line with existing data, we show that repeat ablation is safe in regard to procedural details, short-or long-term safety profile in a large, real-world cohort [6,20,22].…”

Section: Discussionsupporting

confidence: 89%

Safety and patient-reported outcomes in index ablation versus repeat ablation in atrial fibrillation: insights from the German Ablation Registry

et al. 2020

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Background Pulmonary vein isolation is an established strategy for catheter ablation of atrial fibrillation (AF). However, in a significant number of patients, a repeat procedure is mandatory due to arrhythmia recurrence. In this study, we report safety data and procedural details of patients undergoing index ablation versus repeat ablation in a registry-based real-life setting. Methods Patients from the German Ablation Registry, a prospective, multicentre registry of patients undergoing ablation between January 2007 and January 2010 were included. Results A total of 4155 patients were enrolled in the study. Group I (index ablation) consisted of 3377/4155 (82.1%) and group II (repeat ablation) of 738/4155 (17.9%). Patients in group I had a significantly higher ratio of paroxysmal AF (69.3% vs 61.9%, p < 0.001) and significantly less persistent AF (30.7% vs 38.1%, p < 0.001). The repeat group showed significantly lower mean RF application duration (2580 s. vs 1960, p < 0.001), less fluoroscopy time (29 min. vs. 27 min., p < 0.001), less mean dose area product (DAP) (3744 cGy × cm2 vs 3325 cGy × cm2, p = 0.001), and shorter study duration (181.2 min. vs 163.6 min., p < 0.001). No statistical difference between the groups was found in terms of mortality (0.3% vs 0.1%, p = 0.39), MACE (0.4% vs 0.3%, p = 0.58), MACCE (0.8% vs 0.6%, p = 0.47), composite safety endpoint (1.5% vs 1.4%, p = 0.76), and arrhythmia recurrence (43.8% vs 41.9%, p = 0.37) during 1-year follow-up. Both groups reported to have improved or no symptoms (80.4% vs 77.8%, p = 0.13). Conclusion Repeat catheter ablation is safe and provides a symptomatic relief comparable to index ablation. Repeat procedures are significantly shorter and use less fluoroscopy.

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Section: Discussionsupporting

confidence: 89%

Safety and patient-reported outcomes in index ablation versus repeat ablation in atrial fibrillation: insights from the German Ablation Registry

et al. 2020

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“…Perimitral (PM) atrial flutter (AFL) revolving around the mitral annulus is reportedly the most common pattern of tachycardia, accounting for approximately 50% of total macro-reentrant tachycardia. [1–3] Radiofrequency (RF) catheter ablation is often required to treat PM AFLs. Linear ablation with bidirectional conduction block (BDB) achievement is essential to treat PM AFLs.…”

Section: Introductionmentioning

confidence: 99%

Alternative strategies to improve success rate of mitral isthmus block

Lee

Nam

et al. 2018

Medicine

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Achieving bidirectional conduction block (BDB) across the mitral isthmus (MI) is technically challenging. We describe our experience using different ablation strategies for achieving successful MI block.We reviewed the records of patients who had undergone MI ablation for peri-mitral (PM) flutter at our institution from January 2010 to May 2015. We investigated ablation strategies for achieving MI block and their long-term outcomes in terms of recurrence of atrial tachyarrhythmia.Single endocardial MI ablation with or without distal coronary sinus (CS) ablation achieved MI block in 129 out of 236 (54.7%) patients. After failure of MI block, a new MI line ablation, ablation targeting the vein of Marshall (VOM), or anterior line ablation was performed in selected patients. The MI block was achieved in 13 (52.0%) out of 25 patients with new MI line ablation and in 13 (68.4%) out of 19 patients with VOM ablation. Anterior line ablation was tried in 23 patients and the line of block was achieved in 12 (52.2%) patients. Finally, overall PM BDB (PMB, MI block or anterior line block) was achieved in 167 (70.8%) of 236 patients. The incidence atrial tachyarrhythmia was similar between the patients with successful PMB and those with failed PMB (32.9% vs 42.0%, P = .18). In multivariable Cox regression analysis, the PMB was not associated with recurrence of atrial tachyarrhythmia (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.43–1.12).In conclusion, single endocardial MI line with or without distal CS ablation showed limited success for achieving MI block. Additional substrate modifications such as a new MI line ablation, anterior line ablation, or ablation targeting the VOM may improve the success rate of PMB block. However, the benefits of PMB were not clear in this study.

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“…However, although patients are oftentimes more symptomatic when having AT instead of AF, AT as the mode of recurrence usually can be better mapped, ablated, and terminated than AF as the mode of recurrence. Interestingly, as shown by Ammar‐Busch et al., the occurrence of multiple AT forms during the repeat ablation procedure may be seen as a predictive factor for AT recurrence following catheter ablation for persistent AF …”

Section: Discussionmentioning

confidence: 99%

Insights into ablation of persistent atrial fibrillation: Lessons from 6‐year clinical outcomes

Brooks

Metzner

Wohlmuth

et al. 2018

Cardiovasc electrophysiol

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Atrial Tachycardias Following Persistent Atrial Fibrillation Ablation: Predictors of Recurrence After the Repeat Ablation

Cited by 9 publications

References 30 publications

Safety and patient-reported outcomes in index ablation versus repeat ablation in atrial fibrillation: insights from the German Ablation Registry

Safety and patient-reported outcomes in index ablation versus repeat ablation in atrial fibrillation: insights from the German Ablation Registry

Alternative strategies to improve success rate of mitral isthmus block

Insights into ablation of persistent atrial fibrillation: Lessons from 6‐year clinical outcomes

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