title: The incremental benefit of non-pulmonary vein left atrial ablation in patients undergoing a repeat persistent atrial fibrillation ablation procedure.
abstract: OBJECTIVE
  Atrial fibrillation (AF) recurrence after an initial persistent AF ablation procedure is high, frequently resulting in the need for a repeat AF ablation procedure. Guidance on the optimal strategy for repeat procedures is non-existent. The objective of this study was to compare the freedom from recurrent atrial arrhythmia associated with two strategies for repeat persistent AF ablation procedure: (1) pulmonary vein re-isolation alone and (2) non-pulmonary vein LA ablation in addition to pulmonary vein re-isolation.
  
  
  METHODS
  A retrospective multi-center case-controlled study was undertaken. Time-to-recurrent AF with each strategy was assessed using Kaplan-Meier curves. A Cox proportional-hazards regression model was used to determine time-dependent predictors of recurrent AF after the repeat procedure in the entire cohort.
  
  
  RESULTS
  Ninety-eight patients were included in the cohort-39 patients who did not undergo additional LA ablation and 59 patients who had did. AF after the repeat procedure occurred in 38 % of the cohort during a mean follow-up of 18 ± 11 months. Additional LA ablation at the repeat procedure was not associated with a less arrhythmia recurrence (HR = 1.55, p = 0.28). The only variable associated with arrhythmia recurrence after the repeat procedure was additional LA ablation during the initial ablation procedure (HR = 4.13, p = 0.005).
  
  
  CONCLUSIONS
  LA ablation in addition to pulmonary vein re-isolation during a repeat persistent AF ablation procedure was not associated with reduced arrhythmia recurrence after a repeat persistent AF ablation procedure.
authors.affiliation: Schulich Heart Program, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
authors.forename: Gustavo R
authors.initials: GR
authors.lastname: Goldenberg
authors.affiliation: Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Masa
authors.initials: M
authors.lastname: Ono
authors.affiliation: Mercy General Hospital and Dignity Health Heart & Vascular Institute, Sacramento, CA, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Aryana
authors.affiliation: Instituto de Pesquisa em Arritmia Cardiaca - Hospital Cardiologico, Florianopolis, SC, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
authors.affiliation: Center for Atrial Fibrillation, Hospital Pro-Cardiaco, Rio de Janeiro, RJ, Brazil.
authors.forename: Eduardo B
authors.initials: EB
authors.lastname: Saad
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Schulich Heart Program, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. sheldon.singh@sunnybrook.ca.
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods* / Q000706:statistics & numerical data*; D002908:Chronic Disease; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D038622:Internationality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Complex fractionated atrial electrograms; Pulmonary vein isolation