Pulmonary vein reconnection patterns following repeat electrophysiological procedures for recurrent atrial fibrillation
V Nemeth, P K Kupo, K J JanosiAbstract
Background/Introduction
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Even after successful PVI procedures, AF can recure. Nevertheless, these recurrences are frequently driven by PV reconnections. Single-shot devices and point-by-point radiofrequency ablation create lesions with distinct biophysical properties, raising the question of whether they are associated with different PV reconnection patterns.
Aims
To describe PV reconnection patterns in patients undergoing repeat electrophysiological procedures for recurrent AF and to compare these patterns between initial point-by-point ablation and single-shot PVI.
Methods
We retrospectively analyzed 105 consecutive patients who underwent a repeat electrophysiological procedure in a single center study between 2021 and 2023 due to recurrent AF after PVI. Based on the initial ablation strategy, patients were divided into two groups: PP (n=65) versus SS (n=40). During the repeat procedures, all PVs were systematically remapped and assessed for electrical reconnections. The number of reconnected PVs per patient, the distribution of reconnection across PVs, and procedural characteristics were compared between groups using standard statistical methods.
Results
There was no significant difference in the proportion of patients without PV reconnection between the two groups (PP: 19/65, 29% vs. SS: 7/40, 18%; p=0.18). When all veins were considered, 40% in the PP group and 47% in the SS group showed reconnection (PP: 105/260, 40% vs. SS: 75/160, 47%; p=0.30). In contrast, right-sided PV reconnection was significantly more frequent following initial SS ablation (PP: 37/65, 57% vs. SS: 31/40, 78%; p=0.03). No significant difference was observed for left-sided PVs (PP: 24/65, 37% vs. SS: 18/40, 45.0%; p=0.38). Procedural duration, fluoroscopy time, and radiation dose during the repeat procedures did not differ significantly between the two groups.
Conclusions
Approximately one in four patients undergoing repeat procedures after PVI showed no PV reconnection, suggesting durable isolation and non-PV drivers in the initiation of AF. Among patients with reconnection, initial ablation with SS devices was associated with a higher number of right-sided PV reconnection.A 3D electroanatomical mapRight sided PV reconnections