Recurrence after “long-term success” in catheter ablation of paroxysmal atrial fibrillation

Usui, Eisuke; Miyazaki, Shinsuke; Taniguchi, Hiroshi; Ichihara, Noboru; Kanaji, Yoshihisa; Takagi, Takamitsu; Iwasawa, Jin; Kuroi, Akio; Nakamura, Hiroaki; Isobe, Mitsuaki; Hirao, Kazuyuki; Iesaka, Yoshito

doi:10.1016/j.hrthm.2015.01.043

Cited by 20 publications

(32 citation statements)

References 22 publications

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“…Aging process of the heart and remodeling of the atrium contribute to development of ectopic triggers at non-PV sites. 37 Moreover, non-PV triggers are known to be highly prevalent in females, which explain higher rate of AF recurrences after PVAI in women. 38,39 The findings from these published trials are in accordance with the results of our study documenting the role of non-PV triggers for late recurrences.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results-A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions-In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers. (Circ Arrhythm Electrophysiol. 2016;9:e003660.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Most arrhythmia recurrences are identified within the first year after the procedure, while further long-term follow-up strategy for initially “successfully” treated patients is less well defined and inconsistently reported123456789.…”

mentioning

confidence: 99%

Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Mujović

Marinković

Marković

et al. 2017

Sci Rep

105

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Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), Catheter-ablation (CA) is superior to antiarrhythmic drugs (AADs) in patients with symptomatic atrial fibrillation (AF), but AF may re-occur despite multiple re-do procedures and recent technical improvements 1,2 . Most arrhythmia recurrences are identified within the first year after the procedure, while further long-term follow-up strategy for initially "successfully" treated patients is less well defined and inconsistently reported 1-9 .Several studies described a progressive increase in the arrhythmia recurrence rates over time in patients with initial post-ablation suppression of AF 4-6 . It is reported that 10-40% of patients who were arrhythmia free within the first post-procedural year experienced very late recurrence of AF (VLRAF) over long-term follow-up 2-9 . Several scoring systems (i.e., the APPLE, ALARMc and BASE-AF2 score) were recently proposed to predict the short-term risk of AF recurrence after the procedure 10-12 . However, none of these scores have addressed VLRAF occurring in patients who were free of AF at 1 year post procedure. Importantly, reliable identification of increased risk of VLRAF could strongly influence decision-making regarding the long-term use of oral anticoagulation and/or AAD therapy as well as the long-term monitoring strategy after the procedure 1,2 . Due to altered risk/benefit ratio, multiple AF ablation procedures may not be justified in patients at high risk of recurrent AF, and reliable prediction of VLRAF could optimize the patient selection for re-do CA 1,2,9,11 .

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“…17 Recurrences may reflect reconnection of the pulmonary veins or emergence of new foci, suggesting that the underlying substrate evolves despite the procedures. 18 The results for CBA versus RFA seem to be comparable and the lack of cure seems to be broadly observed as noted in a recent meta-analysis from Cheng and colleagues. 19 They showed a similar freedom from AF at more than 16 months follow-up for both CBA (66.9%) and RFA (65.1%).…”

Section: Radiofrequency Ablation/ Cryoballoon Ablation: a Cure For Atmentioning

confidence: 53%

Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry?

Wedam

Haigney

2015

Cardiac Electrophysiology Clinics

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Recurrence after “long-term success” in catheter ablation of paroxysmal atrial fibrillation

Cited by 20 publications

References 22 publications

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry?

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