Atrial Tachycardias Following Persistent Atrial Fibrillation Ablation: Predictors of Recurrence After the Repeat Ablation.
BACKGROUND
Repeat procedures after persistent atrial fibrillation (AF) ablation are frequently performed for secondary atrial tachycardias (AT). Predictors of AT recurrence after the first repeat ablation have not yet been studied.


METHODS
We investigated predictors of AT recurrence in 117 patients who underwent ablation for secondary AT arising after a previous ablation for persistent AF using the Cox proportional hazards model.


RESULTS
Acute ablation success rate was 94%. Over a follow-up period of 12 months, 61 patients (53%) were free from AT recurrence. Of the assessed predictors of AT recurrence, the number of ablated AT forms (>1 vs. 1) was significantly associated with AT recurrence (hazard ratio 2.01, 95% CI 1.18-3.43, P = 0.01). Other variables including left atrial diameter, AT mechanism, or the characteristics of previous AF ablation did not have significant influence on AT recurrence (P>0.05). Men had a tendency toward fewer AT recurrences than women (OR 0.60, 95% CI 0.34-1.05, P = 0.07). During a second AT ablation procedure, 19 (49%) patients were identified to have a recurrence of the previously ablated AT, whereas in 20 patients (51%) a new AT form was diagnosed.


CONCLUSIONS
Ablation of atrial tachycardias following persistent AF ablation has a high acute success rate. However, a substantial number of patients develop new onset AT during follow-up. The occurrence of multiple AT forms during the repeat ablation procedure was the only predictive factor for AT recurrence.
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Sonia
S
Ammar-Busch
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Bernhard M
BM
Kaess
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Alexandra
A
Bruhm
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Tilko
T
Reents
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Felix
F
Bourier
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Alessandra
A
Buiatti
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Verena
V
Semmler
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Marta
M
Telishevska
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Marc
M
Kottmaier
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Gabriele
G
Hessling
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany.
Isabel
I
Deisenhofer
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy*; D016279:Atrial Function, Left; D017115:Catheter Ablation; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011667:Pulmonary Veins; D012008:Recurrence; D019233:Retreatment; D012727:Sex Characteristics; D013612:Tachycardia, Ectopic Atrial / Q000209:etiology*
atrial fibrillation; atrial tachycardia; catheter ablation; complex fractionated atrial electrograms, pulmonary vein isolation; recurrence