학술논문
Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study
Document Type
Academic Journal
Author
Benali, Karim; Barré, Valentin; Hermida, Alexis; Galand, Vincent; Milhem, Antoine; Philibert, Séverine; Boveda, Serge; Bars, Clément; Anselme, Frédéric; Maille, Baptiste; André, Clémentine; Behaghel, Albin; Moubarak, Ghassan; Clémenty, Nicolas; Da Costa, Antoine; Arnaud, Marine; Venier, Sandrine; Sebag, Frédéric; Jésel-Morel, Laurence; Sagnard, Audrey; Champ-Rigot, Laure; Dang, Duc; Guy-Moyat, Benoit; Abbey, Selim; Garcia, Rodrigue; Césari, Olivier; Badenco, Nicolas; Lepillier, Antoine; Ninni, Sandro; Boulé, Stéphane; Maury, Philippe; Algalarrondo, Vincent; Bakouboula, Babé; Mansourati, Jacques; Lesaffre, François; Lagrange, Philippe; Bouzeman, Abdeslam; Muresan, Lucian; Bacquelin, Raoul; Bortone, Agustin; Bun, Sok-Sithikun; Pavin, Dominique; Macle, Laurent; Martins, Raphaël P.
Source
Circulation: Arrhythmia and Electrophysiology. Feb 20, 2023
Subject
Language
English
ISSN
1941-3084
Abstract
BACKGROUND:: Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS:: Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS:: Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13–2.23]; P=0.006). CONCLUSIONS:: In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.