title: Reablated Sites of Acute Reconnection After Pulmonary Vein Isolation Do Not Predict Sites of Late Reconnection at Repeat Electrophysiology Study.
abstract: BACKGROUND
  Acute reconnection of pulmonary veins (PVs) is frequently seen in the waiting period following pulmonary vein isolation (PVI). There are concerns that reablation at these sites may not be durably effective due to tissue edema caused by the initial ablation. We aimed to prospectively study the relationship between acute and late reconnection.
  
  
  RESULTS
  Wide-area circumferential PVI was performed in 40 paroxysmal AF patients. Spontaneous reconnection was assessed after a minimum 20-minute waiting period, with adenosine administered to unmask dormant reconnection. All sites of acute reconnection were ablated to reisolate the PV. All 40 patients then underwent repeat electrophysiology study after 2 months, regardless of symptoms, to identify late reconnection. Sites of acute and late reconnection were compared according to a 12-segment PVI model. Acute reconnection was seen in 28 (6%) PVI segments in 20 (50%) patients, affecting 24/160 (15%) PVs. All were successfully reisolated. At repeat electrophysiology study, 51 (11%) PVI segments were reconnected in 25 (62%) patients, affecting 41 (25%) PVs. The proportion of PVI segments with and without acute reconnection exhibiting late reconnection at repeat study was no different (14% vs. 10%, P = 0.524). There was also no difference in late reconnection between PVI circles or patients with and without acute reconnection.
  
  
  CONCLUSIONS
  Most PVI segments that undergo further ablation for acute reconnection show persistent isolation at repeat electrophysiology study, and the rate of late reconnection for these segments is no different to that for segments that did not acutely reconnect. This implies that effective reablation is delivered at these sites.
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Moloy
authors.initials: M
authors.lastname: DAS
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Wynn
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Maureen
authors.initials: M
authors.lastname: Morgan
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Ronayne
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Johan E P
authors.initials: JE
authors.lastname: Waktare
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Derick M
authors.initials: DM
authors.lastname: Todd
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Mark C S
authors.initials: MC
authors.lastname: Hall
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Snowdon
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Modi
authors.affiliation: Institute of Cardiovascular Medicine and Science, Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gupta
mesh_terms: D000208:Acute Disease; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000517:prevention & control / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome
keywords: acute reconnection; adenosine; atrial fibrillation; catheter ablation; late reconnection; pulmonary vein isolation; pulmonary vein reconnection