Author + information
- Received September 17, 2018
- Revision received October 23, 2018
- Accepted November 15, 2018
- Published online January 30, 2019.
- Jan De Pooter, MD, PhDa,b,∗ (, )
- Teresa Strisciuglio, MDa,
- Milad El Haddad, PhDa,
- Michael Wolf, MDa,
- Thomas Phlips, MDa,
- Yves Vandekerckhove, MDa,
- René Tavernier, MD, PhDa,
- Sebastien Knecht, MD, PhDa and
- Mattias Duytschaever, MD, PhDa,b
- aDepartment of Cardiology, Sint-Jan Hospital, Bruges, Belgium
- bHeart Center, Ghent University Hospital, Ghent, Belgium
- ↵∗Address for correspondence:
Dr. Jan De Pooter, Ghent University Hospital, Heart Center, De Pintelaan 185, 9000 Ghent, Belgium.
Objectives This study sought to determine the prevalence of patients with 4 isolated veins at repeat ablation after “CLOSE” -guided pulmonary vein isolation (PVI), a strategy based on delivery of contiguous and optimized radiofrequency lesions.
Background The likelihood of finding 4 isolated veins at a repeat ablation for atrial fibrillation (AF) recurrence after a first PVI is low.
Methods Patients undergoing repeat ablation for AF recurrence after first CLOSE-guided PVI were included. At repeat, 1) the status of the PV was evaluated and 2) high-density voltage mapping was performed. In case of pulmonary vein reconnection (PVR), veins were reisolated. In patients with 4 isolated veins, empirical trigger or substrate ablation was performed.
Results Of 326 patients undergoing CLOSE-guided PVI for paroxysmal AF, 45 patients underwent repeat ablation for AF recurrence (11 ± 7 months after first PVI). In 28 patients, all veins were still isolated (62%). They showed similar clinical characteristics and similar time from first PVI to AF recurrence (8 ± 7 vs. 6 ± 6 months, respectively, p = 0.453) compared with patients with PVR. In contrast, they were characterized by a higher incidence of low voltage (57% vs. 17%, p = 0.033). Patients with 4 isolated veins, compared with patients treated for PVR, showed a lower 12-month freedom from AF after repeat ablation (61% vs. 88%, p = 0.045).
Conclusions After CLOSE-guided ablation, PVR is no longer the rule in patients with AF recurrence. Patients with AF recurrence and 4 isolated veins present with a similar clinical profile and time to recurrence as patients with PVR.
Dr. El Haddad is a consultant to Biosense Webster. 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 September 17, 2018.
- Revision received October 23, 2018.
- Accepted November 15, 2018.
- 2019 American College of Cardiology Foundation
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