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Characterizing Recurrent Atrial Fibrillation After Catheter Ablation: Patterns of Pulmonary Vein Reconnection and Predictors of Complete Pulmonary Vein Isolation
Session:
Sessão de Posters 13 - Ablação de fibrilhação auricular
Speaker:
Ana Inês Aguiar Neves
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Inês Aguiar Neves; Marta Leite; João Gonçalves Almeida; Mariana Ribeiro Silva; Rafael Teixeira; Fabio Nunes; Marta Catarina Almeida; Paulo Fonseca; Helena Gonçalves; Marco Oliveira; João Primo; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Introduction: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Recurrence of atrial fibrillation (AF) after catheter ablation is frequently due to pulmonary vein (PV) reconnection. However, some patients have AF recurrences despite durable pulmonary vein isolation (PVI). We aimed to assess the characteristics of patients referred to reablation procedures, including PV reconnection patterns, and to determine predictors of complete PVI. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"> Retrospective, single-centre study including all consecutive patients undergoing PVI for AF between 2017 and 2021. Ablation procedures included conventional radiofrequency ablation (2017), CLOSE-protocol guided radiofrequency ablation (2018-2021) and second-generation cryoballoon. Recurrence was defined by the identification of an atrial arrhythmia (AF or atrial flutter) after a 90-day blanking period.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Results: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">PVI was performed in 767 patients (36% female; mean age 59±8 years; mean CHA<sub>2</sub>DS<sub>2</sub>VASc score 1.4±1.2; 77% of patients had paroxysmal AF). Median follow-up was 29 months. Recurrence of atrial arrhythmia was identified in 230</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"> patients</span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">(30%). Seventy-nine patients (38% female; mean age 59±8.5 years) underwent a reablation procedure. Patients who underwent reablation were less likely to have chronic kidney disease and to have an evident source for AF on electroanatomical mapping (p <0.05 for all). They were more likely to have moderate to severe valvular disease, left atrial dilatation, concomitant flutter, longer history of AF, previous electrical cardioversions, symptomatic recurrences, and to have antiarrhythmic medication reintroduced (p <0.05 for all). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Median</span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">time from index ablation to recurrence was 1</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">2</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"> months, while the </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">median</span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">time to reablation was 1</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">6</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"> months. Patients who suffered recurrence between six to twelve months after the ablation procedure were more likely to undergo reablation (41% vs. 26%, p=0.040</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">In </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">60 </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">patients </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">(76%) </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">with evidence of PV reconnection</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">, </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">28 (41%) had reconnection of the left superior PV, 26 (38%) had reconnection of the left inferior PV, 36 (53%) had reconnection of the right superior PV, and 44 (64%) had reconnection of the right inferior PV. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Complete PVI was identified in 1</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">9</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"> patients (</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">24</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">%). Patients with complete PVI were more likely to have dyslipidaemia (</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">68</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">% vs. 4</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">2</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">%, p=0.0</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">4</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">8)</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">, chronic kidney disease (21% vs. 3%, p = 0.029), to have undergone CLOSE-protocol guided radiofrequency ablation during the index procedure (94% vs. 55%, p=</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">0.003), </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">and to have fibrosis on electroanatomical mapping </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">during the index procedure </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">(</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">33</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">% vs. </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">7</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">%, p</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">=0.015</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">).</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"> PV reconnection was not associated with recurrence within one year after index ablation. On logistic regression, no factors were found to be </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">independent</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">ly</span></span> <span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">associated with complete PV</span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">I.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Conclusions: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">AF recurrence after catheter ablation is </span></span><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">rare, and PV reconnection is commonly detected during reablation procedures. No independent factors were consistently associated with complete PVI.</span></span> </span></span></p>
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