Objectives: To categorize arrhythmia mechanisms and to summarize ablation strategies in patients ... more Objectives: To categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent PVI at the time of a redo procedure. Background: Persistent pulmonary vein isolation (PVI) is more frequently seen in patients undergoing a redo procedure for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF). Methods: Consecutive patients who had their first AF ablation procedure at Brigham and Women's Hospital were screened and included if they had persistent isolation of all PVs at the time of a redo procedure. Results: Of 300 consecutive patients undergoing a first AF ablation procedure, redo procedures were performed in 63 (21%) and 26 patients (9%) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure linear ablation was performed in 46% of patients with recurrent AF and 93% with recurrent organized AT (p=0.020). At the time of last follow up 2/10 (20%) patients in the AF group, and 10/15 (67%) patients in AT group were in sinus rhythm, off of Class I or III antiarrhythmic drugs (p=0.022). Conclusions: Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized ATs. Linear ablation during the index procedure is associated with recurrence of organized ATs. Recurrence rates after a redo procedure are higher if patients had recurrent AF after the index procedure and these patients often present with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.
Circulation. Arrhythmia and electrophysiology, 2012
Inducibility of atrial fibrillation (AF) after pulmonary vein isolation has been used to guide ad... more Inducibility of atrial fibrillation (AF) after pulmonary vein isolation has been used to guide additional left atrial ablation in paroxysmal AF. The sensitivity and specificity of AF induction in this setting remains uncertain. We examined the incidence and characteristics of inducible AF in patients without structural heart disease or clinical AF and the effect of different induction protocols on AF inducibility. In 44 patients with supraventricular tachycardia with no history of AF or risk factors for AF, atrial refractoriness and conduction were measured, followed by AF induction attempts (10/patient). Each induction was performed after a waiting time that exceeded twice the duration of induced AF from the preceding induction. AF≥1 minute was considered inducible, and ≥5 minutes as sustained. Burst pacing (at 200 ms for 10 seconds) was compared to decremental pacing (from 200 ms to shortest cycle length, resulting in 1:1 atrial capture for 10 seconds). After 10 inductions, AF was...
Objectives: To categorize arrhythmia mechanisms and to summarize ablation strategies in patients ... more Objectives: To categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent PVI at the time of a redo procedure. Background: Persistent pulmonary vein isolation (PVI) is more frequently seen in patients undergoing a redo procedure for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF). Methods: Consecutive patients who had their first AF ablation procedure at Brigham and Women's Hospital were screened and included if they had persistent isolation of all PVs at the time of a redo procedure. Results: Of 300 consecutive patients undergoing a first AF ablation procedure, redo procedures were performed in 63 (21%) and 26 patients (9%) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure linear ablation was performed in 46% of patients with recurrent AF and 93% with recurrent organized AT (p=0.020). At the time of last follow up 2/10 (20%) patients in the AF group, and 10/15 (67%) patients in AT group were in sinus rhythm, off of Class I or III antiarrhythmic drugs (p=0.022). Conclusions: Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized ATs. Linear ablation during the index procedure is associated with recurrence of organized ATs. Recurrence rates after a redo procedure are higher if patients had recurrent AF after the index procedure and these patients often present with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.
Circulation. Arrhythmia and electrophysiology, 2012
Inducibility of atrial fibrillation (AF) after pulmonary vein isolation has been used to guide ad... more Inducibility of atrial fibrillation (AF) after pulmonary vein isolation has been used to guide additional left atrial ablation in paroxysmal AF. The sensitivity and specificity of AF induction in this setting remains uncertain. We examined the incidence and characteristics of inducible AF in patients without structural heart disease or clinical AF and the effect of different induction protocols on AF inducibility. In 44 patients with supraventricular tachycardia with no history of AF or risk factors for AF, atrial refractoriness and conduction were measured, followed by AF induction attempts (10/patient). Each induction was performed after a waiting time that exceeded twice the duration of induced AF from the preceding induction. AF≥1 minute was considered inducible, and ≥5 minutes as sustained. Burst pacing (at 200 ms for 10 seconds) was compared to decremental pacing (from 200 ms to shortest cycle length, resulting in 1:1 atrial capture for 10 seconds). After 10 inductions, AF was...
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