Recurrence of pulmonary vein conduction and atrial fibrillation after pulmonary vein isolation for atrial fibrillation: A randomized trial of the ostial versus the extraostial ablation strategy

Nilsson, Brian; Chen, Xu; Pehrson, Steen; Køber, Lars; Hilden, Jørgen; Svendsen, Jesper Hastrup

doi:10.1016/j.ahj.2006.05.029

Cited by 105 publications

(109 citation statements)

References 27 publications

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“…[2][3][4][5][6] Electrical reconnection in these studies was usually observed in patients who had recurrence of AF after these procedures and was thought to be the mechanism in most patients. 5,6,12,13 The rate of AF recurrence in our study (35%) was nearer the lower end of the range reported in previous studies, for a cohort with a third of patients who have persistent or long-standing persistent AF. Reconnection of the previously isolated PLA and pulmonary veins was seen in all patients with recurrent AF in the present series.…”

Section: Recurrent Af After Left Atrial Ablation and The Role Of Plamentioning

confidence: 99%

“…The reported success rates for ablation procedures range from 48% to 88% for paroxysmal AF and 0% to 79% for chronic AF after a single procedure. [1][2][3][4][5][6] Failure may be due to recurrence of AF and atrial tachycardia due to macroreentry or focal mechanisms. Left atrial reentrant tachycardia has been reported in 6% to 16% of patients with pulmonary vein isolation.…”

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confidence: 99%

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Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation

Lim

Koay

McCall

et al. 2008

Circ: Arrhythmia and Electrophysiology

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Background-Single-ring isolation of the posterior left atrium is feasible, but the incidence and mechanisms of postprocedural arrhythmias have not been described in detail. Methods and Results-The first 100 consecutive patients (58.8Ϯ11.2 years old, 80 male) who underwent single-ring isolation for atrial fibrillation (66 intermittent, 18 persistent, 16 long-standing persistent) were followed up for 9.1Ϯ4.5 months. Recurrences were diagnosed by clinical symptoms and Holter monitoring. Patients with recurrences of sustained atrial arrhythmia Ͼ3 months after the procedure were offered a repeat procedure and were studied to determine the mechanisms of recurrence. Forty-six patients (46%) experienced sustained postprocedural atrial arrhythmias (35 had atrial fibrillation, and 34 had atrial flutter). Of these, 34 required a second procedure 7.0Ϯ3.1 months after their initial procedure. Reconnection of the posterior left atrium was seen in all patients with atrial fibrillation. Atrial flutter was most commonly due to mitral isthmus-dependent macroreentry (nϭ8, cycle length 368Ϯ116 ms) or macroreentry through 2 gaps in the ring of lesions (nϭ6, cycle length 328Ϯ115 ms). Posterior left atrium reisolation was achieved at the second procedure in all patients. Atrial flutter was successfully ablated and rendered noninducible in all patients. Six months after their last procedure, the Kaplan-Meier estimate of freedom from recurrence for all 100 patients was 81Ϯ5%. Conclusions-Atrial

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Section: Recurrent Af After Left Atrial Ablation and The Role Of Plamentioning

confidence: 99%

mentioning

confidence: 99%

Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation

Lim

Koay

McCall

et al. 2008

Circ: Arrhythmia and Electrophysiology

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“…Recovery of conduction between the atrium and the pulmonary veins is a common finding in patients with AF recurrence after ablation, even if pulmonary vein isolation was adequately documented during the procedure. 67,68 Recovery of conduction may be due, in part, to local tissue regeneration in nontransmural ablation lesions and reversibility of thermal injury seems to be an important determinant of recovery of conduction. 69 Colchicine could intervene in this process through its antiproliferative action, inhibiting electric reconnection in thermal injury ablation sites.…”

Section: Maintenance Post Ablation Colchicinementioning

confidence: 99%

Status of Antiarrhythmic Drug Development for Atrial Fibrillation

Hanley

Robinson

Kowey

2016

Circ: Arrhythmia and Electrophysiology

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“…The effect of RASIs might be supplemental and limited and become significant after a malignant remodelling cycle caused by frequent AF events has been removed by PVI. If the LA-PV reconduction as a main cause of AF recurrence after PVI [35][36] occurs, resulting in frequent AF episodes, the malignant remodelling cycle would restart and RASIs would no longer exert their suppressive effect on AF. Although several experimental findings have been promising, the effect of RASIs on AF as an upstream therapy might be limited and should not be overestimated.…”

Section: The Role Of Rasis In Af Preventionmentioning

confidence: 99%

Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

Takigawa

Yamada

Yoshida

et al. 2012

J Renin Angiotensin Aldosterone Syst

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Introduction: The purpose of this study was to investigate whether the effects of renin-angiotensin system inhibitors (RASIs) after encircling ipsilateral pulmonary veins isolation (EIPVsI) for atrial fibrillation (AF) differed between patients with non-dilated and dilated left atria. Materials and methods: We retrospectively studied 292 consecutive patients (mean age=61±11 years, 75% males) who underwent successful EIPVsI for paroxysmal or persistent AF. RASIs' effects were compared between the patients with a non-dilated left atrium of <40 mm (n=178) and dilated left atrium of ≥40 mm (n=114). Results: During a mean follow-up period of 18.9±12.7 months, AF recurred in 38 (21.4%) and 45 (39.5%) patients with non-dilated and dilated left atria, respectively. A multivariate Cox proportional analysis revealed that treatment with RASIs (hazard ratio (HR) 0.30, 95% confidence interval (CI) =0.13-0.66, p=0.003), the duration of AF (HR 1.08/year, 95% CI=1.01-1.16, p=0.03), a history of hypertension (HR 2.86, 95% CI=1.21-6.85, p=0.02) and the left ventricular ejection fraction (HR 0.54/10%↑, 95% CI=0.34-0.87, p=0.01) were associated with AF recurrences in patients with a non-dilated left atrium. On the other hand, only the duration of AF (HR 1.11/year, 95% CI=1.01-1.21, p=0.03) was associated with AF recurrences in those with a dilated LA, and RASIs had no effect on AF recurrences (p=0.65). Conclusions: RASIs suppressed AF recurrences after EIPVsI only in patients with a non-dilated left atrium.

show abstract

Recurrence of pulmonary vein conduction and atrial fibrillation after pulmonary vein isolation for atrial fibrillation: A randomized trial of the ostial versus the extraostial ablation strategy

Cited by 105 publications

References 27 publications

Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation

Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation

Status of Antiarrhythmic Drug Development for Atrial Fibrillation

Renin–angiotensin system inhibitors can suppress atrial fibrillation recurrence after encircling ipsilateral pulmonary vein isolation in patients with a non-dilated left atrium

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