Strategic factors to reduce recurrence after trido catheter ablation for atrial fibrillation
Y Choi, C O Seo, J H Jeong, Y G Kim, J Shim, J I Choi, Y H KimAbstract
Background
Despite pulmonary vein isolation (PVI) being the cornerstone of atrial fibrillation (AF) ablation, arrhythmia recurrence remains common, particularly in patients undergoing multiple procedures. This study aimed to identify procedural factors associate with reduced recurrence after a third (Trido) catheter ablation (CA) of AF.
Methods
Among 3,238 consecutive patients who underwent CA for AF, 157 patients (mean age 59.8±10.8 years, 19.1% female) underwent a Trido procedure and were retrospectively analysed. Patients were divided into recurrence and non-recurrence groups according to post-procedural outcomes.
Results
During a median follow-up of 29.8 months, arrhythmia recurrence occurred in 89(56.7%) of patients. Posterior wall electrical isolation (PWEI) was associated with significantly lower recurrence compared with those without PWEI (31.0% vs. 62.5%, log-rank P=0.006), as was non-pulmonary vein (non-PV) trigger ablation (45.7% vs. 61.3%, P=0.046). In contrast, re-ablation of reconnected PVs showed no benefit (HR 0.95, 95% CI 0.63–1.45, P=0.814). In multivariate Cox regression, PWEI (HR 0.35, 95% CI 0.17–0.72, P=0.005) was independently associated with reduced recurrence, whereas complex fractionated atrial electrogram ablation (HR 2.01, 95% CI 1.27-3.35, P=0.004) predicted a higher recurrence risk.
Conclusion
In patients undergoing a third catheter ablation for AF, solid PVI remains fundamental; however, adjunctive strategies such as posterior wall isolation and non-PV trigger ablation independently lowered the risk of arrhythmia recurrence. Conversely, CFAE ablation was associated with a higher recurrence rate. Optimizing ablation strategy with selective posterior wall and non-PV trigger ablation may improve long-term outcomes in patients requiring multiple procedures.