Pulmonary vein reconnection and arrhythmia progression after antral linear catheter ablation of paroxysmal and persistent atrial fibrillation

Assumption of different substrates is the basis for different ablation strategies in patients with paroxysmal and persistent atrial fibrillation (AF). We aimed to investigate pulmonary vein reconnection and influence on progression of initial paroxysmal (pAF) versus persistent atrial fibrillation (perAF).

Between January 2010 and November 2012, 149 patients (117 men, mean age 59 ± 11 years, range 27–80 years) underwent at least one redo antral pulmonary vein isolation (PVI) using NavX-guided irrigated-tip radiofrequency catheter ablation. We analyzed whether and where reconnection of pulmonary veins was detected, and whether there were differences between patients with pAF and perAF.

Of the 149 patients who underwent a redo antral PVI, 80 patients had pAF and 69 had perAF. One, two and three redo PVIs were performed in 149, 26 and 6 patients, respectively. Reconnection of at least one PV was detected in all patients at the second PVI, in 19 of 26 patients (73 %) at the third PVI and 5 of 6 patients (83 %) at the fourth PVI. 20 (29 %) patients with perAF prior to the first PVI had pAF at the second PVI, whereas 15 (19 %) patients with initial pAF had persistent AF at the time of the first redo procedure. From the second to the third PVI, four patients had developed perAF after previous pAF and two with per AF now had pAF. PV reconnection was observed independent of underlying AF type. At the second redo procedure, of those with reconnected veins 12 had pAF and 13 perAF. At the third redo procedure, four patients had pAF and four perAF.

Most patients with recurrent AF after PVI showed at least one reconnected vein during redo procedures. Reconnection was identified irrespective of the underlying AF type. Progression from pAF to perAF and vice versa was observed irrespective of the initial AF type.