Author + information
- Received May 29, 2018
- Revision received September 24, 2018
- Accepted September 27, 2018
- Published online November 28, 2018.
- Gabor Sandorfi, MDa,
- Moises Rodriguez-Mañero, MD, PhDb,c,d,
- Johan Saenen, MD, PhDa,
- Aurora Baluja, MD, PhDe,
- Wim Bories, MSBME, MSE, CEPSa,
- Wim Huybrechts, MDa,
- Hielko Miljoen, MDa,
- Lien Vandaele, BSa,
- Hein Heidbuchel, MD, PhDa and
- Andrea Sarkozy, MD, PhDa,∗ ()
- aCardiology Department, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
- bCardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
- cInstituto de Investigación Sanitaria (IDIS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- dCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226-CB16/11/00420), Santiago de Compostela, Spain
- eAnesthesiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
- ↵∗Address for correspondence:
Dr. Andrea Sarkozy, Cardiology Department, University Hospital Antwerp, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Objectives This study investigated whether real-world use of contemporary technologies changed pulmonary vein (PV) reconnection and redo pulmonary vein isolation (PVI) procedure frequencies.
Background Previous studies consistently reported that following PVI recurrence of PV conduction is observed in >80% of patients.
Methods Consecutive patients undergoing 529 first and/or redo radiofrequency point-by-point PVI between January 2013 and December 2016 were included.
Results Between 2013 and 2016, redo PVI rate in atrial fibrillation significantly decreased (p < 0.001); in ≤12 months, first redo PVI rate decreased from 19% to 4%. The percentage of patients having PV reconnection at second PVI significantly decreased from 90% to 29% (p = 0.001). One PVI was performed in 393 and >1 in 79 patients. Female sex was associated with >1 PVI (hazard ratio [HR]: 1.86; 95% confidence interval [CI]: 1.10 to 3.13, p = 0.02). Sixty patients underwent first and second PVI in the study period. Female sex (HR: 2.79; 95% CI: 1.67 to 4.64; p < 0.001) and left atrial diameter (HR: 1.05; 95% CI: 1.01 to 1.08; p = 0.01) were associated with more and use of automatic ablation annotation algorithm during first PVI with fewer (HR: 0.54; 95% CI: 0.32 to 0.92; p = 0.02) redo PVI procedures. In 31 of 60 patients, ≥1 PV was reconnected at second PVI. The need for “touch-up” applications at the first PVI was the only predictor of PV reconnection.
Conclusions Redo rate in atrial fibrillation and PV reconnection at redo PVI significantly decreased in recent years. Male sex, left atrial diameter, and use of automatic ablation annotation algorithm at first PVI were associated with fewer redo procedures. First-pass isolation was associated with lower PV reconnection rate at second procedure. Female sex was associated with more redo procedures but not higher PV reconnection frequencies.
Dr. Sandorfi received a clinical fellowship grant from Biosense Webster Inc. and the European Heart Rhythm Association. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 29, 2018.
- Revision received September 24, 2018.
- Accepted September 27, 2018.
- 2018 American College of Cardiology Foundation
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