title: Acute pulmonary vein reconnection is a predictor of atrial fibrillation recurrence following pulmonary vein isolation.
abstract: OBJECTIVE
  Arrhythmia recurrence following pulmonary vein isolation (PVI) occurs predominantly due to the reconnection of previously isolated pulmonary veins (PVs). The prognostic implications of detection and treatment of acute PV reconnection are not well understood. We aim to examine the prognostic significance of acute PV reconnection on arrhythmia recurrence at 1 year following PVI.
  
  
  METHODS
  This prospective study included 44 patients (22 men, 60 ± 7 years) who underwent index PVI procedure for treatment of atrial fibrillation (AF). Acute PV reconnection and/or dormant PV conduction were assessed sequentially in response to a 30-min waiting period, intravenous isoproterenol infusion and/or adenosine. All cases of acute PV reconnection and/or dormant conduction were successfully targeted with additional ablation.
  
  
  RESULTS
  Freedom from AF at 1 year was 75 % (83.3 % in paroxysmal and 65 % in persistent AF, p = ns). Acute PV reconnection and/or dormant conduction were evident in 16 of 44 patients (36.3 %). AF recurrence was documented in eight of 16 patients with, but only in three of 28 patients without acute reconnection (p = 0.009). Three patients underwent a redo procedure, all from the group of patients with acute PV reconnection. In a multivariate model, acute PV reconnection was a strong independent predictor of arrhythmia recurrence (hazards ratio [HR], 6.36; 95 % confidence interval [CI], 1.12-31.6).
  
  
  CONCLUSIONS
  Identification of acute PV reconnection, even when successfully targeted, is a strong predictor of arrhythmia recurrence following PVI.
authors: Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, 85 Pilgrim Road, Baker 4, Boston, MA, 02215, USA, eanter@bidmc.harvard.edu.
authors: Elad
authors: E
authors: Anter
authors: Fernando M
authors: FM
authors: Contreras-Valdes
authors: Alexei
authors: A
authors: Shvilkin
authors: Cory M
authors: CM
authors: Tschabrunn
authors: Mark E
authors: ME
authors: Josephson
mesh_terms: D000241:Adenosine; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D002316:Cardiotonic Agents; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007545:Isoproterenol; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D000241:Adenosine; D007545:Isoproterenol