Repeat procedure is a new independent predictor of complications of atrial fibrillation ablation

Szegedi, Nándor; Herczeg, Szilvia; Treuer, Tamás; Salló, Zoltán; Nagy, Vivien Klaudia; Osztheimer, István; Özcan, Emin Evren; Merkely, Béla; Gellér, László

doi:10.1093/europace/euy326

Cited by 40 publications

(38 citation statements)

References 20 publications

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“…The 1‐year success rate of 66% is consistent with prior reports (59%–92%) 4–9 . However, our major complication rate of 1.3% is lower than previously reported (2.8%–3.9%) 8,12,14 . Therefore, our comprehensive report on efficacy and safety confirms and extends findings from earlier eras of AF ablation and provides current data on anticipated outcomes.…”

Section: Discussionsupporting

confidence: 90%

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Repeat catheter ablation for recurrent atrial fibrillation: Electrophysiologic findings and clinical outcomes

Daimee

Akhtar

Boyle

et al. 2021

Cardiovasc electrophysiol

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Introduction Atrial fibrillation (AF) ablation is successful in 60%–80% of optimal candidates, with many patients requiring repeat procedures. We performed a detailed examination of electrophysiologic findings and clinical outcomes associated with first repeat AF ablations in the era of contact force‐sensing radiofrequency (RF) catheters. Methods We retrospectively studied patients who underwent their first repeat AF ablations for symptomatic, recurrent AF at our center between 2013 and 2019. All repeat ablations were performed using contact force‐sensing RF catheters. Pulmonary vein (PV) reconnections at repeat ablation and freedom from atrial arrhythmia 1 year after repeat ablation were evaluated. We further assessed these findings based on AF classification at the time of presentation for repeat ablation, index RF versus cryoballoon (CB) ablation, and duration (≥3 versus <3 years) between index and repeat procedures. Results Among 300 patients, there were 136 (45.3%) who presented for their first repeat ablations in persistent AF. During repeat ablation, at least one PV reconnection was found in 257 (85.6%) patients, while 159 (53%) had three to four reconnections. There was a similar distribution of reconnections among patients with persistent versus paroxysmal AF (mean: 2.7 ± 1.3 vs. 2.9 ± 1.2; p = .341), index RF versus CB ablation (mean: 2.8 ± 1.3 vs. 2.9 ± 1.2; p = .553), and ≥3 versus <3 years between index and repeat procedures (mean: 3.0 ± 1.1 vs. 2.7 ± 1.3; p = .119). At repeat ablation, the PVs were re‐isolated in all patients, and additional non‐PV ablation was performed in 171 (57%) patients. Freedom from atrial arrhythmia at 1‐year follow‐up after repeat ablation was 66%, similar among those with persistent versus paroxysmal AF (65.4% vs. 66.5%; p = .720), index RF versus CB ablation (66.7% vs. 68.9%; p = .930), and ≥3 versus <3 years between index and repeat ablations (64.4% vs. 66.7%; p = .760). Major complications occurred in a total of 4 (1.3%) patients. Conclusion In a contemporary cohort of patients receiving their first repeat AF ablations using contact force‐sensing RF catheters, PV reconnections were common, and freedom from atrial arrhythmia was 66% at 1‐year follow‐up. The distributions of PV reconnections and rates of freedom from atrial arrhythmia were similar, based on persistent versus paroxysmal AF at presentation for repeat ablation, index RF versus CB ablation, and duration between index and repeat procedures. The incidence of major complications was very low.

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Section: Discussionsupporting

confidence: 90%

“…A limited number of studies have examined the effect of initial radiofrequency (RF) versus cryoballoon (CB) ablation on outcomes after repeat ablation, reporting similar rates of freedom from atrial arrhythmia and another re‐ablation procedure 10,11 . Repeat procedures may also be associated with increased complications 12 …”

Section: Introductionmentioning

confidence: 99%

Repeat catheter ablation for recurrent atrial fibrillation: Electrophysiologic findings and clinical outcomes

Daimee

Akhtar

Boyle

et al. 2021

Cardiovasc electrophysiol

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“…Importantly, the single-shot technique based redo strategy used by us was not related to an increased percentage of complications; on the contrary, there was only a 2% rate of minor complications during redos. This stands in contrast to the point-by-point technique, where redo procedures were shown to be an independent predictor of major complications (odds ratio 3.6) [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of atrial fibrillation ablation program based on single-shot techniques

Jastrzębski

Kiełbasa

Fijorek

et al. 2020

pwki

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Introduction Single-shot techniques such as cryoballoon and multipolar phased pulmonary vein ablation catheter (PVAC) are an alternative to the point-by-point radiofrequency method for atrial fibrillation (AF) ablation. However, there is a lack of data concerning sequential use of single-shot techniques, that is, for both the index and redo ablation. Aim To assess long-term outcomes of the ‘single-shot techniques only’ AF ablation strategy. Material and methods We analyzed all consecutive AF ablations performed over a 10-year period (2009–2019) in a center where a ‘single-shot technique only’ principle was followed from the start of the AF ablation program. Kaplan-Meier AF-free survival curves were calculated and complications were assessed on the basis of our prospectively maintained database. Results A total of 597 patients (62.4 ±12.5 years) with paroxysmal (78.1%) or persistent (21.9%) AF entered the study and 655 AF ablation procedures were performed. In 96.5% of redos ( n = 58) a different technique (mostly PVAC) was used than for the index ablation (mostly cryoballoon). The Kaplan-Meier estimates of 1, 2 and 5 years freedom from AF were 78.2%, 69.2%, and 56.0%, for the index ablation, and 80.3%, 76.1% and 68.3%, for the redo, respectively. The minor and major complication rates were 8.1%, and 4.0%, respectively. Conclusions An AF ablation program based solely on sequential use of two different single-shot techniques for both index and redo procedures is safe and effective. These observations might have important practical implications for new operators/centers starting AF ablation programs and for use of single-shot techniques for redo procedures.

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“…Although radiofrequency (RF) catheter ablation is an established and recommended treatment option for paroxysmal AF (PAF), 2 recovery of ablated tissue and reconnection of at least one pulmonary vein (PV) has been reported in up to 70% of AF patients following pulmonary vein isolation (PVI) 2,3 . In fact, pulmonary vein reconnection (PVR) has been identified as a major driving factor of AF recurrence, 4‐6 which may result in repeat ablations, increased medical costs, 7 and higher risk of complications 8 . Creating durable lesions during PVI is therefore critical to prevent PVR and subsequent recurrence of arrythmia 2,9,10 …”

Section: Introductionmentioning

confidence: 99%

Characterizing clinical outcomes and factors associated with conduction gaps in VISITAG SURPOINT‐guided catheter ablation for atrial fibrillation

Inoue

Tanaka

Ikada

et al. 2021

Journal of Arrhythmia

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Purpose Although usefulness of VISITAG SURPOINT (VS) on pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation has been reported, optimal VS thresholds can depend on the inter‐tag distance (ITD) and vice versa. We validated the efficacy of PVI with lower target ITDs and VS values than in previous studies. Methods Retrospective review of consecutive patients (N = 100) with paroxysmal (n = 32) or persistent AF (n = 68) undergoing VS‐guided ablation between 09/2018 and 08/2019 was conducted. All procedures were performed by two operators. Target VS values were 425 (anterior), 375 (posterior), and 325 (near the esophagus). Target ITD was 4 mm. Results Acute PVI was achieved in all cases, however, 13 residual gaps in 12 patients were observed after initial encirclement (first pass isolation: 88%). Ten gaps due to spontaneous PV reconnections (PVR) were found in nine patients (9%). These 23 gaps had similar median VS (gap‐related vs non‐gap: 429 vs 410, P = .4545) and power (36 vs 36W, P = .4843), higher contact force (13.8 vs 11.0g, P = .0061), and larger ITD (5.3 vs 3.7mm, P < .001) when compared to the remaining tags. Only ITDs were independently associated with gap formation in multivariate analysis. One‐year Kaplan‐Meier freedom from any atrial arrhythmia was 87.2%. Eight patients received repeat ablation (8.1%) and of these, 6 (75%) were free from PVR. Conclusion Favorable rates of first pass isolation, acute PVR, and long‐term procedure success were achieved using lower VS values than in previous reports. With a target VS value of 375‐425, ITDs of 4 mm was sufficient for durable PVI.

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Repeat procedure is a new independent predictor of complications of atrial fibrillation ablation

Cited by 40 publications

References 20 publications

Repeat catheter ablation for recurrent atrial fibrillation: Electrophysiologic findings and clinical outcomes

Repeat catheter ablation for recurrent atrial fibrillation: Electrophysiologic findings and clinical outcomes

Outcomes of atrial fibrillation ablation program based on single-shot techniques

Characterizing clinical outcomes and factors associated with conduction gaps in VISITAG SURPOINT‐guided catheter ablation for atrial fibrillation

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