Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation

• Published in: Circulation (New York, N.Y.) Vol. 108; no. 13; pp. 1599 - 1604
• Main Authors: CAPPATO, Riccardo, NEGRONI, Silvia, PECORA, Domenico, BENTIVEGNA, Stefano, LUPO, Pier Paolo, CAROLEI, Adriana, ESPOSITO, Cristina, FURLANELLO, Francesco, DE AMBROGGI, Luigi
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 30.09.2003; American Heart Association, Inc
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biological and medical sciences; Catheter Ablation; Disease-Free Survival; Diseases of the cardiovascular system; Electric Conductivity; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Treatment Outcome; Human; Conduction; Recurrence; Arrhythmia; Pathophysiology; Treatment efficiency; Atrial fibrillation; Instrumentation therapy; Electrophysiology; Cardiovascular disease; Exploration; catheter ablation; Excitability disorder; Incidence; Treatment; Heart disease; Radiofrequency irradiation; Complication; Pulmonary vein; fibrillation
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000091081.19465.F1

In patients with atrial fibrillation (AF) undergoing radiofrequency (RF) electrical disconnection of multiple pulmonary veins (PVs), the incidence of late conduction recurrences has not been systematically determined. Using a prospectively designed, multistep approach, we aimed at assessing the correlation between acute achievement and chronic maintenance of electrical conduction block across RF lesions disconnecting the distal tract of the PV in 43 patients (52.3+/-8.2 years) with AF. Forty-one left superior (LS), 42 right superior (RS), 25 left inferior (LI), and 9 right inferior (RI) PVs were targeted during 108 EP procedures (2.6+/-0.5 per patient). Seventeen patients underwent 2 procedures, 23 patients underwent 3 procedures, and 3 patients underwent 4 procedures. During the first attempt, electrical disconnection was achieved in 112 PVs (95.7%). During a next procedure (time interval, 4.6+/-1.9 months), conduction recurrence was observed in 32 of 39 LSPVs (82.1%), 29 of 40 RSPVs (72.5%), 20 of 24 LIPVs (83.3%), and 7 of 9 RIPV (77.8%). After reablation at gap sites, a later procedure (time interval, 5.1+/-2.4 months) revealed a second recurrence in 13 of 22 LSPVs (59.1%) and 14 of 19 RSPVs (73.7%). Conduction recurrence across disconnecting RF lesions can be observed in approximately 80% of cases 4 months after ablation. After reablation, similar recurrence rates are observed 5 months later. This high rate of late conduction recurrence may contribute significantly to AF recurrence in patients undergoing catheter ablation aiming at disconnection of multiple PVs.