title: Interventional management of recurrent paroxysmal atrial fibrillation despite isolated pulmonary veins: impact of an ablation strategy targeting inducible atrial tachyarrhythmias.
abstract: OBJECTIVE
  Pulmonary vein isolation (PVI) is an effective treatment option for paroxysmal atrial fibrillation (PAF). Reconnection of pulmonary veins (PVs) is the predominant cause for recurrence of PAF. However, treatment of patients with recurrence of PAF despite isolated PV in the absence of extra-PV foci remains challenging.
  
  
  RESULTS
  Of 265 patients undergoing repeat catheter ablation (CA) for recurrence of PAF 21 (8%) patients (14 men, age 58 ± 14 years) showed no reconnection of PV. Therefore, inducibility of sustained atrial arrhythmias was tested. If sustained atrial fibrillation (AF) or sustained atrial tachycardia (AT) was induced, patients underwent CA. During follow-up (FU), Holter- and Tele-electrocardiogram were performed. In 19 (91%) of 21 patients, sustained atrial arrhythmias [16 (84%) AF; 3 (15%) patients AT] were induced. One patient showed PAF. Eighteen patients underwent CA aiming for termination of induced arrhythmia. In 14 (77%) patients, termination into sinus rhythm was achieved. Despite extensive CA, three (16%) patients were externally cardioverted. No periprocedural complications occurred. During 21.2 ± 6.8-month FU, 10 (53%) patients were free of any arrhythmia. Paroxysmal atrial fibrillation recurred in 4 (21%) and AT in 5 (26%) patients. One patient showed persistent AF. Repeat CA was scheduled and successfully performed for these patients.
  
  
  CONCLUSIONS
  In patients with recurrence of PAF despite isolated PV, termination of induced atrial arrhythmias can be achieved in most patients by defragmentation and AT ablation. Moreover, this ablation strategy results in favourable mid-term outcome results.
authors.affiliation: Department of Electrophysiology, University of Cologne, Heart Center, Kerpener Strasse 62, Cologne 50937, Germany arian.sultan@uk-koeln.de.
authors.forename: Arian
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Department of Electrophysiology, University of Cologne, Heart Center, Kerpener Strasse 62, Cologne 50937, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Lüker
authors.affiliation: Division of Cardiac Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hoffmann
authors.affiliation: Division of Cardiac Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.affiliation: Division of Cardiac Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schäffer
authors.affiliation: Department of Electrophysiology, University of Cologne, Heart Center, Kerpener Strasse 62, Cologne 50937, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.affiliation: Division of Cardiac Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006325:Heart Atria / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D013610:Tachycardia / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: Ablation; Inducible atrial tachyarrhytmias; Paroxysmal atrial fibrillation; Pulmonary vein isolation