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Prevalence and predictor factors of persistent pulmonary vein isolation in redo AF ablation procedure
Session:
CO 03 - Flutter/atrial fibrilation
Speaker:
Mariana Ribeiro Silva
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Ribeiro Da Silva; Gualter Santos Silva; Pedro Ribeiro Queirós; Rafael Teixeira; João Almeida; Paulo Fonseca; Marco Oliveira; Helena Gonçalves; Alberto Rodrigues; João Primo; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Atrial fibrillation (AF) catheter ablation <span style="color:black">is a well-established procedure for the treatment of AF. The cornerstone of AF ablation is the complete isolation of pulmonary veins (PV). However, persistent PV isolation (PVI) is difficult to accomplish, with PV reconnection rates of > 70%. The factors associated with persistent PVI are still uncertain.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To assess the PVI status in patients undergoing a redo ablation and to determinate the predictors associated with persistent PVI.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Consecutive patients who underwent a redo ablation between 2016 and 2020 were identified in a single-centre retrospective study. PVI status was assessed during electrophysiologic study with electroanatomic mapping system. Index procedures included second generation cryoballoon (CB), conventional radiofrequency (RF) before 2018 and “CLOSE” protocol guided RF ablation after 2018. Persistent PVI was defined by the absence of reconnection of all pulmonary veins.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results and Discussion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We included 83 patients with a mean age of 55,9±11,9 years; 71,1% (n=59) were male with a <span style="color:black">mean CHA2DS2-VASc score</span> of 1,14 ±1,0. Seventy-five percent had paroxysmal AF and undergone a redo 35,0 months (±30,9) after the index PVI. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Seventeen patients (20,5%) had persistent PVI whereas 66 patients (79,5%) had at least one PV reconnected after the index procedure, with a reconnection rate of 51,8% for right superior and inferior PV, 47,0% for left superior PV and 36,1% for left inferior PV.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">No statistically significant differences were noticed between patients with persistent and non-persistent PVI in baseline (clinical and echocardiographic characteristics).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Regarding index ablation procedure, persistent PVI occurred more frequently in patients who underwent a “CLOSE” protocol-guided index PVI compared to RF pre-2018 and CB (45,5% vs 16,7%; p=0,043).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Twenty-nine percent of patients with persistent PVI had a “CLOSE” protocol-guided index PVI whereas only 9,1% of non-persistent PVI patients had a “CLOSE”-guided index PVI (p=0,043). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In this cohort, “CLOSE” protocol-guided index PVI was the only predictor of persistent PVI (odds ratio 4.2, 95% confidence interval 1.1-15.9; p=0.037).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In patients undergoing redo AF ablation procedures, only 20,5% had persistent PVI. “CLOSE” protocol-guided index PVI presented significantly higher rates of persistent PVI. “CLOSE” protocol-guided index PVI was the only predictor for persistent PVI in patients with AF recurrence requiring a redo procedure. </span></span></p>
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