Skip to main content
Top
Published in: Journal of Interventional Cardiac Electrophysiology 2/2020

01-11-2020 | Atrial Fibrillation

Clinical and electrophysiological characteristics predicting the re-ablation outcome for atrial fibrillation patients

Authors: Changqing Miao, Weizhu Ju, Hongwu Chen, Gang Yang, Fengxiang Zhang, Kai Gu, Mingfang Li, Zidun Wang, Hailei Liu, Minglong Chen

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2020

Login to get access

Abstract

Background

Re-ablation has an important role in the control of recurrent atrial fibrillation (AF) post the first ablation. The present study was to report the outcome of AF re-ablation for patients who recurred after initial ablation, and to characterize the clinical and electrophysiological features predicting recurrence after redo ablation.

Methods

From January 2012 to May 2017, patients undergoing re-ablation for AF in our hospital were consecutively enrolled. Clinical and electrophysiological data for the initial and second procedure were collected retrospectively and prospectively, respectively. All patients were followed up for one year and recurrences during the time were reported.

Results

Totally 259 patients entered into the analysis (age, 58.4 ± 10.5 years; 169 men). At the end of one-year follow-up, 85 patients recurred with atrial arrhythmias (32.8%). In the multivariate analysis, higher CHA2DS2-VASC score (p = 0.023, 95% CI 1.03–1.53) and shorter time to recurrence after the initial ablation (p = 0.001, 95% CI 0.93–0.98) were clinical factors predictive of one-year recurrence after the repeat ablation. The reconnection of the right pulmonary vein (PV) (p = 0.034, 95% CI 0.31–0.96) and the absence of not eliminated non-PV trigger at the second procedure (p = 0.032, 95% CI 1.25–142.80) independently predicted the better re-ablation outcome.

Conclusions

About one-third of patients recurred after one year following re-ablation. CHA2DS2-VASC score and time to recurrence after the initial ablation were independent clinical factors predicting recurrence. Also, electrophysiological findings during the repeat ablation (the right PV reconnection and absence of not eliminated non-PV trigger) were associated with better outcome during one year of follow-up.
Literature
1.
go back to reference Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.CrossRefPubMed Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.CrossRefPubMed
2.
go back to reference Ouyang F, Bansch D, Ernst S, Schaumann A, Hachiya H, Chen M, et al. Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation. Circulation. 2004;110(15):2090–6.CrossRefPubMed Ouyang F, Bansch D, Ernst S, Schaumann A, Hachiya H, Chen M, et al. Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation. Circulation. 2004;110(15):2090–6.CrossRefPubMed
3.
go back to reference European Heart Rhythm A, European Cardiac Arrhythmia S, American College of C, American Heart A, Society of Thoracic S, Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2007;4(6):816–61.CrossRef European Heart Rhythm A, European Cardiac Arrhythmia S, American College of C, American Heart A, Society of Thoracic S, Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, et al. HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2007;4(6):816–61.CrossRef
4.
go back to reference Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation. 2010;122(23):2368–77.CrossRefPubMed Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation. 2010;122(23):2368–77.CrossRefPubMed
5.
go back to reference Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012;9(4):632–696 e621.PubMed Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012;9(4):632–696 e621.PubMed
6.
go back to reference Barakat AF, Wazni OM, Saliba WI, Yzeiraj E, Amuthan R, Abdur Rehman K, et al. Repeat ablation or medical management alone for recurrent arrhythmias after ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2018;29(4):551–8.CrossRefPubMed Barakat AF, Wazni OM, Saliba WI, Yzeiraj E, Amuthan R, Abdur Rehman K, et al. Repeat ablation or medical management alone for recurrent arrhythmias after ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2018;29(4):551–8.CrossRefPubMed
7.
go back to reference Yang B, Jiang C, Lin Y, Yang G, Chu H, Cai H, et al. STABLE-SR (electrophysiological substrate ablation in the left atrium during sinus rhythm) for the treatment of nonparoxysmal atrial fibrillation: a prospective, multicenter randomized clinical trial. Circ Arrhythm Electrophysiol. 2017;10(11). Yang B, Jiang C, Lin Y, Yang G, Chu H, Cai H, et al. STABLE-SR (electrophysiological substrate ablation in the left atrium during sinus rhythm) for the treatment of nonparoxysmal atrial fibrillation: a prospective, multicenter randomized clinical trial. Circ Arrhythm Electrophysiol. 2017;10(11).
8.
go back to reference Yang G, Yang B, Wei Y, Zhang F, Ju W, Chen H, et al. Catheter ablation of nonparoxysmal atrial fibrillation using electrophysiologically guided substrate modification during sinus rhythm after pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2016;9(2):e003382.PubMed Yang G, Yang B, Wei Y, Zhang F, Ju W, Chen H, et al. Catheter ablation of nonparoxysmal atrial fibrillation using electrophysiologically guided substrate modification during sinus rhythm after pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2016;9(2):e003382.PubMed
9.
go back to reference Winkle RA, Mead RH, Engel G, Patrawala RA. Long-term results of atrial fibrillation ablation: the importance of all initial ablation failures undergoing a repeat ablation. Am Heart J. 2011;162(1):193–200.PubMed Winkle RA, Mead RH, Engel G, Patrawala RA. Long-term results of atrial fibrillation ablation: the importance of all initial ablation failures undergoing a repeat ablation. Am Heart J. 2011;162(1):193–200.PubMed
10.
go back to reference Takigawa M, Takahashi A, Kuwahara T, Okubo K, Takahashi Y, Nakashima E, et al. Impact of non-pulmonary vein foci on the outcome of the second session of catheter ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2015;26(7):739–46.PubMed Takigawa M, Takahashi A, Kuwahara T, Okubo K, Takahashi Y, Nakashima E, et al. Impact of non-pulmonary vein foci on the outcome of the second session of catheter ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2015;26(7):739–46.PubMed
11.
go back to reference Winkle RA, Mead RH, Engel G, Kong MH, Fleming W, Salcedo J, et al. Impact of obesity on atrial fibrillation ablation: patient characteristics, long-term outcomes, and complications. Heart Rhythm. 2017;14(6):819–27.PubMed Winkle RA, Mead RH, Engel G, Kong MH, Fleming W, Salcedo J, et al. Impact of obesity on atrial fibrillation ablation: patient characteristics, long-term outcomes, and complications. Heart Rhythm. 2017;14(6):819–27.PubMed
12.
go back to reference Anter E, Di Biase L, Contreras-Valdes FM, Gianni C, Mohanty S, Tschabrunn CM, et al. Atrial substrate and triggers of paroxysmal atrial fibrillation in patients with obstructive sleep apnea. Circ Arrhythm Electrophysiol. 2017;10(11). Anter E, Di Biase L, Contreras-Valdes FM, Gianni C, Mohanty S, Tschabrunn CM, et al. Atrial substrate and triggers of paroxysmal atrial fibrillation in patients with obstructive sleep apnea. Circ Arrhythm Electrophysiol. 2017;10(11).
13.
go back to reference Nakamori S, Ngo LH, Tugal D, Manning WJ, Nezafat R. Incremental value of left atrial geometric remodeling in predicting late atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study. J Am Heart Assoc. 2018;7(19):e009793.PubMedPubMedCentral Nakamori S, Ngo LH, Tugal D, Manning WJ, Nezafat R. Incremental value of left atrial geometric remodeling in predicting late atrial fibrillation recurrence after pulmonary vein isolation: a cardiovascular magnetic resonance study. J Am Heart Assoc. 2018;7(19):e009793.PubMedPubMedCentral
14.
go back to reference Jacobs V, May HT, Bair TL, Crandall BG, Cutler M, Day JD, et al. The impact of risk score (CHADS2 versus CHA2DS2-VASc) on long-term outcomes after atrial fibrillation ablation. Heart Rhythm. 2015;12(4):681–6.PubMed Jacobs V, May HT, Bair TL, Crandall BG, Cutler M, Day JD, et al. The impact of risk score (CHADS2 versus CHA2DS2-VASc) on long-term outcomes after atrial fibrillation ablation. Heart Rhythm. 2015;12(4):681–6.PubMed
15.
go back to reference Letsas KP, Efremidis M, Giannopoulos G, Deftereos S, Lioni L, Korantzopoulos P, et al. CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation. Europace. 2014;16(2):202–7.PubMed Letsas KP, Efremidis M, Giannopoulos G, Deftereos S, Lioni L, Korantzopoulos P, et al. CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation. Europace. 2014;16(2):202–7.PubMed
16.
go back to reference Kornej J, Hindricks G, Kosiuk J, Arya A, Sommer P, Husser D, et al. Comparison of CHADS2, R2CHADS2, and CHA2DS2-VASc scores for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation: the Leipzig Heart Center AF Ablation Registry. Circ Arrhythm Electrophysiol. 2014;7(2):281–7.PubMed Kornej J, Hindricks G, Kosiuk J, Arya A, Sommer P, Husser D, et al. Comparison of CHADS2, R2CHADS2, and CHA2DS2-VASc scores for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation: the Leipzig Heart Center AF Ablation Registry. Circ Arrhythm Electrophysiol. 2014;7(2):281–7.PubMed
17.
go back to reference Gaztanaga L, Frankel DS, Kohari M, Kondapalli L, Zado ES, Marchlinski FE. Time to recurrence of atrial fibrillation influences outcome following catheter ablation. Heart Rhythm. 2013;10(1):2–9.PubMed Gaztanaga L, Frankel DS, Kohari M, Kondapalli L, Zado ES, Marchlinski FE. Time to recurrence of atrial fibrillation influences outcome following catheter ablation. Heart Rhythm. 2013;10(1):2–9.PubMed
18.
go back to reference Ouyang F, Ernst S, Chun J, Bansch D, Li Y, Schaumann A, et al. Electrophysiological findings during ablation of persistent atrial fibrillation with electroanatomic mapping and double Lasso catheter technique. Circulation. 2005;112(20):3038–48.PubMed Ouyang F, Ernst S, Chun J, Bansch D, Li Y, Schaumann A, et al. Electrophysiological findings during ablation of persistent atrial fibrillation with electroanatomic mapping and double Lasso catheter technique. Circulation. 2005;112(20):3038–48.PubMed
19.
go back to reference Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005;111(2):127–35.PubMed Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005;111(2):127–35.PubMed
20.
go back to reference Nanthakumar K, Plumb VJ, Epstein AE, Veenhuyzen GD, Link D, Kay GN. Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation. 2004;109(10):1226–9.PubMed Nanthakumar K, Plumb VJ, Epstein AE, Veenhuyzen GD, Link D, Kay GN. Resumption of electrical conduction in previously isolated pulmonary veins: rationale for a different strategy? Circulation. 2004;109(10):1226–9.PubMed
21.
go back to reference Lemola K, Hall B, Cheung P, Good E, Han J, Tamirisa K, et al. Mechanisms of recurrent atrial fibrillation after pulmonary vein isolation by segmental ostial ablation. Heart Rhythm. 2004;1(2):197–202.PubMed Lemola K, Hall B, Cheung P, Good E, Han J, Tamirisa K, et al. Mechanisms of recurrent atrial fibrillation after pulmonary vein isolation by segmental ostial ablation. Heart Rhythm. 2004;1(2):197–202.PubMed
22.
go back to reference Yoshida K, Hattori A, Tsuneoka H, Tsumagari Y, Yui Y, Kimata A, et al. Electrophysiological relation between the superior vena cava and right superior pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2017;28(10):1117–26.PubMed Yoshida K, Hattori A, Tsuneoka H, Tsumagari Y, Yui Y, Kimata A, et al. Electrophysiological relation between the superior vena cava and right superior pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2017;28(10):1117–26.PubMed
23.
go back to reference DeSimone CV, Noheria A, Lachman N, Edwards WD, Gami AS, Maleszewski JJ, et al. Myocardium of the superior vena cava, coronary sinus, vein of Marshall, and the pulmonary vein ostia: gross anatomic studies in 620 hearts. J Cardiovasc Electrophysiol. 2012;23(12):1304–9.PubMed DeSimone CV, Noheria A, Lachman N, Edwards WD, Gami AS, Maleszewski JJ, et al. Myocardium of the superior vena cava, coronary sinus, vein of Marshall, and the pulmonary vein ostia: gross anatomic studies in 620 hearts. J Cardiovasc Electrophysiol. 2012;23(12):1304–9.PubMed
24.
go back to reference Lo LW, Lin YJ, Chang SL, Hu YF, Chao TF, Chung FP, et al. Predictors and characteristics of multiple (more than 2) catheter ablation procedures for atrial fibrillation. J Cardiovasc Electrophysiol. 2015;26(10):1048–56.PubMed Lo LW, Lin YJ, Chang SL, Hu YF, Chao TF, Chung FP, et al. Predictors and characteristics of multiple (more than 2) catheter ablation procedures for atrial fibrillation. J Cardiovasc Electrophysiol. 2015;26(10):1048–56.PubMed
25.
go back to reference Lin WS, Tai CT, Hsieh MH, Tsai CF, Lin YK, Tsao HM, et al. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation. 2003;107(25):3176–83.PubMed Lin WS, Tai CT, Hsieh MH, Tsai CF, Lin YK, Tsao HM, et al. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation. 2003;107(25):3176–83.PubMed
26.
go back to reference Ballesteros G, Ravassa S, Bragard J, Ramos P, Lopez B, Vives E, et al. Association of left atrium voltage amplitude and distribution with the risk of atrial fibrillation recurrence and evolution after pulmonary vein isolation. An ultra-high-density mapping study. J Cardiovasc Electrophysiol. 2019. Ballesteros G, Ravassa S, Bragard J, Ramos P, Lopez B, Vives E, et al. Association of left atrium voltage amplitude and distribution with the risk of atrial fibrillation recurrence and evolution after pulmonary vein isolation. An ultra-high-density mapping study. J Cardiovasc Electrophysiol. 2019.
Metadata
Title
Clinical and electrophysiological characteristics predicting the re-ablation outcome for atrial fibrillation patients
Authors
Changqing Miao
Weizhu Ju
Hongwu Chen
Gang Yang
Fengxiang Zhang
Kai Gu
Mingfang Li
Zidun Wang
Hailei Liu
Minglong Chen
Publication date
01-11-2020
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2020
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-019-00666-0

Other articles of this Issue 2/2020

Journal of Interventional Cardiac Electrophysiology 2/2020 Go to the issue