SPC365

Redefining Success in Atrial Fibrillation - Efficacy of Redo Ablation Procedure and Importance of Left Atrial Volume

Session: SESSÃO DE POSTERS 53 - FIBRILHAÇÃO AURICULAR E ARRITMIAS AURICULARES COMPLEXAS
Speaker: Daniel Inácio Cazeiro

Congress: CPC 2025
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Cartazes
FP Number: ---
Authors: Daniel Inácio Cazeiro; Catarina Gregório; Miguel Azaredo Raposo; Ana Abrantes; Céu Barreiros; Joana Brito; Afonso Nunes Ferreira; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In patients with recurrent atrial fibrillation (AF) after pulmonary vein isolation (PVI), repeat ablation can reduce symptoms and prevent disease progression. However, its long-term efficacy varies and is influenced by patient and AF-related factors.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To analyze the efficacy of AF redo ablation and identify predictors of recurrence.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single-center, retrospective study of patients (pts) submitted to AF redo ablation from 2015 to June 2024. The ablation strategy involved PVI with point-by-point radiofrequency in cases of PV reconnection. Complementary ablation strategies were performed, at the operator&#39;s discretion, when extensive left atrial (LA) substrate was identified, including linear lesion deployment or scar homogenization. Ablation of non-PV triggers was also performed when appropriate. Cox regression uni- and multivariate analyses were used to identify risk factors for AF recurrence after the redo procedure.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 231 pts were included (mean age 62 years, 70% male, 57% paroxysmal AF) with a median follow-up of 3.9 years. Most pts (86%) had no evidence of structural heart disease. Median indexed LA volume was 38 mL/m&sup2;, with moderate to severe dilation (&gt;42 mL/m&sup2;) present in 32% of pts. Previous PVI had been performed with RF, PVAC, or cryoablation in 41%, 26%, and 33% of pts, respectively. During the redo procedure, substrate mapping depicted reconduction of &ge;1 PV in 85% of pts; additional low-voltage areas and non-PV triggers were identified in 35% and 5%, respectively. The AF recurrence rates at 1 and 3 years after the redo procedure were 20% and 40%. These pts had a significantly higher median LA volume (40 vs. 34 mL/m&sup2;, p=0.003). LA dilation was the only independent predictor of recurrence after redo, with the effect being more pronounced in patients with volume &gt;42 mL/m&sup2; (HR 2.814, CI 95% 1.221-6.486, p=0.015). Interestingly, pts with persistent AF, compared to paroxysmal AF, experienced a shorter time to recurrence, but this was not statistically significant; redo was efficacious in this subgroup, with recurrence rates at 1 and 3 years of 27% and 47%, respectively.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">AF redo ablation demonstrated a high success rate, with 80% of pts maintaining sinus rhythm at 1 year. These results underscore the pivotal role of this procedure in effective rhythm control of AF, regardless of its duration. LA dilation is an independent predictor of recurrence and may help identify pts who are more likely to benefit from redo ablation.</span></span></span><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"> </span></span></span></p>