title: Recurrence of paroxysmal atrial fibrillation after pulmonary vein isolation: is repeat pulmonary vein isolation enough? A prospective, randomized trial.
abstract: OBJECTIVE
  In patients with paroxysmal atrial fibrillation (pAF), pulmonary vein isolation (PVI) has become an accepted treatment option with single procedure success rates of 60-80%. A repeat ablation is performed in ∼30% of patients because of arrhythmia recurrence. The strategy for this repeat procedure is not defined.
  
  
  RESULTS
  Patients with pAF recurrence after PVI were prospectively randomized and underwent a second ablation procedure with either PVI of all reconnected veins or PVI with an additional left atrial anterior line. Follow-up in our arrhythmia clinic was every 3 months up to 12 months including 7 day Holter monitoring. A total of 77 patients (mean age 63 ± 9 years, 69% males) were included in the analysis. A repeat PVI was performed in 41 patients, PVI + anterior line in 36 patients. After a follow-up of 12 months, 26 of 41 (63%) patients after repeat PVI and 18 of 36 (50%) patients with PVI + anterior line were in stable sinus rhythm off antiarrhythmic medication (P = 0.26). In most patients (12 of 15 patients with PVI and 14 of 18 patients with PVI + anterior line) with an arrhythmia recurrence after the second procedure, the recurring arrhythmia was paroxysmal AF. In 2 of 15 patients of the PVI group and in 4 of 18 patients of the PVI + anterior line group atypical flutter was the reoccurring arrhythmia (P = NS).
  
  
  CONCLUSIONS
  In this prospective randomized trial, patients with a recurrence of paroxysmal AF had no better outcome after repeat PVI + one left atrial line compared with patients with repeat PVI only.
authors.affiliation: Medizinische Klinik I, Klinikum der Universität München, Marchioninistr. 15, Munich 81377, Germany sf@sfichtner.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fichtner
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Korbinian
authors.initials: K
authors.lastname: Sparn
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Roger
authors.initials: R
authors.lastname: Dillier
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Buiatti
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kathan
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.affiliation: Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Anterior line; Atrial fibrillation; PVI; Pulmonary vein isolation; Relapse;