title: Conduction recovery following catheter ablation in patients with recurrent atrial fibrillation and heart failure.
abstract: BACKGROUND
  Atrial fibrillation (AF) catheter ablation is increasingly proposed for patients suffering from AF and concomitant heart failure (HF). However, the optimal ablation strategy remains controversial. We performed this study to assess the prevalence of pulmonary vein (PV) or linear lesion reconnection in HF patients undergoing repeated procedures.
  
  
  RESULTS
  At seven high-volume centres, 165 patients with HF underwent a repeat procedure after a first AF ablation including PV isolation alone (47 patients, group A) or PV isolation plus left atrial lines (118 patients, group B). Group A patients presented more often paroxysmal AF (p<0.001), less enlarged left atrium (p<0.001) and less left ventricular systolic dysfunction (p=0.031) compared to Group B, that more commonly had atypical atrial flutter (p<0.001). Forty-one (87%) patients in Group A and 69 (58%) in Group B presented at least one reconnected PV (p<0.001). Sixty-one (52%) patients in Group B presented at least one reconnected atrial line (left isthmus or roof). Patients without any reconnected PV (n=54, 33%) more frequently experienced persistent AF (p<0.001), had longer AF duration (p=0.047) and larger left atrial volume (p<0.001). Twenty-five patients (15%) with no PV and/or line reconnection did not significantly differ, concerning baseline characteristics, compared to those with at least one reconnected ablation site.
  
  
  CONCLUSIONS
  As in the general AF population undergoing catheter ablation, PV reconnection is frequent in patients with HF and symptomatic recurrence. However, one third of patients presented arrhythmic recurrences even in the absence of PV reconnection, highlighting the importance of the underlying atrial substrate.
authors.affiliation: Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.affiliation: Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Matta
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Murray, UT, USA.
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.affiliation: Department of Cardiology, Heart Centre, Hospital Podlesi as, Třinec, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Fiala
authors.affiliation: Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
authors.affiliation: Department of Cardiology, Westmead Hospital, University of Sydney, Australia.
authors.forename: Pierre
authors.initials: P
authors.lastname: Qian
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumann
authors.affiliation: Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Ferraris
authors.affiliation: Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy. Electronic address: fiorenzo.gaita@unito.it.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000639:trends*; D005260:Female; D006329:Heart Conduction System / Q000502:physiology; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Atrial fibrillation; Heart failure; Linear lesions; Pulmonary veins; Transcatheter ablation