Recurrent atrial tachycardia and atrial fibrillation after circumferential pulmonary vein ablation: what's the difference?
BACKGROUND
Recurrent atrial tachyarrhythmia (ATa) after circumferential pulmonary vein ablation (CPVA) includes atrial tachycardia (AT) and atrial fibrillation (AF). However, whether there are some differences in clinical course and mechanisms between the recurrent AT and the recurrent AF remained unclear. This study was conducted to investigate the incidence, mechanism, clinical course of the recurrent AT and AF in patients under CPVA.


METHODS
One hundred and thirty consecutive patients (M/F = 95/35) with highly symptomatic and multiple antiarrhythmic drugs (AADs) refractory paroxysmal (n = 91) or persistent (n = 39) AF were included. The ablation protocol consisted solely of two continuous circular lesions around the ipsilateral pulmonary veins (PV) guided by CARTO system. The endpoint of CPVA is PV isolation. For patients with recurrent ATa within 2 months after the initial procedure, cardioversion with direct current was attempted if the ATa lasted for more than 24 hours. A repeat ablation procedure was performed only for patients with AADs refractory recurrent ATa and at least followed up for 2 months after the initial procedure.


RESULTS
Within 2 months after the initial procedure, 52 patients (40.0%) had experienced episodes of symptomatic recurrent ATa. Among them, 23 patients (44.2%) with recurred AT alone (AT group), 14 patients (26.9%) with recurred AF alone (AF group), and 15 patients (28.8%) with recurred AT and AF (AT plus AF group). The delayed cure rate (65.2%) in AT group was significant higher than that in AF group (21.4%, P < 0.05) and AF plus AT group (26.7%, P < 0.05). A repeat ablation was performed in 21 patients, including 6 patients with recurrent AT alone, 8 patients with recurrent AF alone, and 7 patients with recurrent AF plus AT. The mean number of PV gaps was 1.2 +/- 0.4 in AT group, which was significantly lower than that in AF group (2.6 +/- 0.7, P < 0.05) and AF plus AT group (2.0 +/- 0.6, P < 0.05). Delayed cure rate and number of PV gaps between AF group and AF plus AT group were comparable (P > 0.05).


CONCLUSIONS
Present study indicates that recurrent AT and AF after CPVA have the different clinical course and different electrophysiological findings during repeat procedure as follows: (1) After CPVA, spontaneous resolution of recurrent ATa was mainly found in patients with recurrent AT alone (about two thirds patients). (2) The type of recurrent ATa after CPVA is associated with the number of PV gaps.
Liu
Xing-peng
XP
Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Science, Beijing 100029, China.
Long
De-yong
DY
Dong
Jian-zeng
JZ
Liu
Xiao-qing
XQ
Fang
Dong-ping
DP
Hao
Peng
P
Ma
Chang-sheng
CS
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D013610:Tachycardia / Q000209:etiology*