Atrial Tachycardia Recurrence After Ablation Redo Procedure

A retrospective analysis of patients following first atrial fibrillation (AF) ablation showed that those with organized atrial tachycardia were more likely to require a redo procedure.

Samuel H. Baldinger, MD, of Brigham and Women’s Hospital in Boston, and colleagues conducted the study to determine which patients or ablation characteristics may dictate the type of atrial arrhythmia recurrence and to find the correct ablation strategy for those patients.

They evaluated results from 300 consecutive patients with AF who had persistent isolation of all pulmonary veins at the time of a redo procedure. Sixty-three patients (21%) had redo procedures and, of those, 26 (9%) had persistent pulmonary vein isolations (PVI).

Their findings were published in JACC: Clinical Electrophysiology.

Eleven patients with persistent PVIs had recurrent AF and 15 had organized atrial tachycardia. During the index procedure, 46% of patients with recurrent AF and 93% with recurrent organized atrial tachycardia (P=.020) underwent linear ablation.

Researchers found that linear ablation during the index procedure was associated with recurrence in patients with organized atrial tachycardia. They added that recurrence rates after a redo procedure were higher if patients had recurrent AF after the index procedure.

At the time of last follow-up, 20% of patients in the AF group and 67% of patients in atrial tachycardia group were in sinus rhythm, and no longer taking Class I or III antiarrhythmic drugs (P=.022).

“Patients with recurrence of atrial arrhythmia despite persistent PVI may present with organized ATs [atrial tachycardia] or AF. Patients who presented with organized ATs frequently had incomplete linear ablation from the index procedure but had a relatively low recurrence rate after the redo procedure,” researchers wrote. “Patients who present with recurrent AF also had incomplete linear ablation, but recurrence rates of AF after a redo procedure remain high even when the redo ablation strategy resulted in AF termination.”

Dr Baldinger and colleagues concluded that completion of the ablation line(s) provided “reasonable medium-term freedom from atrial arrhythmias” in patients with recurrent atrial tachycardias, but the appropriate ablation strategy for these patients is still unclear.

Reference

Baldinger SH, Chinitz JS, Kapur S, et al. Recurrence of atrial arrhythmias despite persistent pulmonary vein isolation after catheter ablation for atrial fibrillation–a case series. JACC Clin Electrophysiol. 2016. doi:10.1016/j.jacep.2016.05.013.