title: Early recurrence of atrial arrhythmias following pulmonary vein antral isolation: Timing and frequency of early recurrences predicts long-term ablation success.
abstract: BACKGROUND
  Early recurrence of atrial arrhythmia (ERAA) is common after atrial fibrillation (AF) ablation and is associated with long-term recurrence. However, the association between timing or frequency of ERAA and long-term ablation success remains unclear.
  
  
  OBJECTIVE
  We aimed to examine whether timing or frequency of ERAA after pulmonary vein antral isolation (PVAI) affects long-term ablation success.
  
  
  METHODS
  Three hundred AF patients (100 paroxysmal, 100 persistent, 100 long-standing persistent; mean age 59.5 ± 9.6 years, 79% male) undergoing PVAI were included. All patients underwent 30-day monitoring with mobile continuous outpatient telemetry after PVAI and were followed for >1 year. ERAA was defined as AF or organized atrial tachycardia (OAT) in the first 6 weeks, and was categorized as early (weeks 1-2), intermediate (weeks 3-4), or late (weeks 5-6). Long-term ablation success was defined as the absence of AF/OAT lasting >30 seconds off antiarrhythmic drugs 1 year after a single ablation (excluding first 6 weeks).
  
  
  RESULTS
  ERAA occurred in 169 patients (53%); of those, 79 (46.7%) had single ERAA and 90 (53.3%) had multiple ERAAs. ERAA occurred less commonly with paroxysmal versus persistent or long-standing persistent AF (46% vs 57% and 66%; P = .017). ERAA was associated with worse ablation success at 1 year (38.1% vs 79.5% [no ERAA]; P < .001). Multiple (vs single) ERAA more strongly predicted long-term ablation failure (OR: 4.5; 95% CI [2.3-8.8]).
  
  
  CONCLUSIONS
  ERAA after PVAI is associated with decreased long-term ablation success. Patients experiencing multiple ERAA events are at greatest risk for long-term arrhythmia recurrence and represent a subgroup in whom early reablation may be considered.
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jackson J
authors.initials: JJ
authors.lastname: Liang
authors.affiliation: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Elafros
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: William W
authors.initials: WW
authors.lastname: Chik
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Supple
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Schaller
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.affiliation: Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: sanjay.dixit@uphs.upenn.edu.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ablation; Arrhythmia; Atrial; Monitoring; Pulmonary vein isolation; fibrillation