title: Efficacy of repeat pulmonary vein isolation procedures in patients with recurrent atrial fibrillation.
abstract: BACKGROUND
  Pulmonary vein (PV) isolation is effective in the treatment of most patients with atrial fibrillation (AF). Some advocate the addition of linear ablation techniques to improve efficacy; however, previous studies suggest recurrent PV conduction is responsible for AF recurrence. The aim of this study was to determine the effectiveness of repeat PV isolation in patients with recurrent AF after an initial ablation procedure and to determine if any patient characteristics predict failure of repeat PV isolation procedures.
  
  
  RESULTS
  Seventy-four patients with two or more AF ablation procedures using selective PV isolation were included. PV isolation was guided with multielectrode ring catheter recordings, electroanatomic mapping, and intracardiac electrocardiography. Radiofrequency energy was delivered using a 4-mm-tip catheter (maximum 40 W, 52 degrees C); cooled-tip ablation was performed in 10 patients. Linear ablation was not performed. Antiarrhythmic drugs were continued for at least 6 weeks after ablation; AF episodes during this period were censored. Reconnection of one or more segments of previously ablated PVs was observed in 97% of patients; reconnected PVs served as the trigger for AF in 77%. Repeat PV isolation resulted in AF control (cure or 90% reduction in AF episodes) in 64 patients (86%) over a follow-up period of 9.1 +/- 6.7 months. "High-risk" characteristics such as left atrial enlargement, persistent AF, or mitral regurgitation did not predict failure of repeat PV isolation procedures.
  
  
  CONCLUSIONS
  Recurrent AF following selective PV isolation is overwhelmingly associated with PV electrical reconnection. Repeat PV isolation without linear ablation provides effective treatment for recurrent AF in patients in whom an initial PV isolation procedure failed, independent of clinical characteristics.
authors.affiliation: Electrophysiology Section, Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. david.callans@uphs.upenn.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Erica
authors.initials: E
authors.lastname: Zado
authors.forename: Mark
authors.initials: M
authors.lastname: Vanderhoff
authors.forename: Jian-Fang
authors.initials: JF
authors.lastname: Ren
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D004452:Echocardiography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome