Is the Time of Atrial Fibrillation Recurrence After Duty-Cycled Radiofrequency Ablation Affected by the Pattern of Pulmonary Vein Reconnections?

BACKGROUND: Pulmonary vein isolation (PVI) with multielectrode duty-cycled radiofrequency (PVAC) has been shown to be effective in the treatment of atrial fibrillation (AF). We describe pulmonary vein (PV) reconnection at repeat ablation in patients with AF recurrence after PVAC PVI and analyze the correlation between the time of AF recurrence and the observed PV reconnection patterns. METHODS: Eighty-five patients undergoing a redo PVI for recurrent AF 9.2 ± 3.8 months after an initial PVAC PVI procedure was retrospectively enrolled. RESULTS: A total of 93% had PV reconnections with a mean of 2.97 ± 1.2 reconnected PVs/patients and 75% of formerly isolated PVs were found reconnected. The highest reconnection rates (94%) were observed for left common trunks (CTs). A total of 33% patients had three and four reconnected PVs, respectively, while 7% were without PV reconnection. There was a moderate but significant negative correlation between the time of AF recurrences and the extending of PV reconnections at redo PVI for patients with proven PV reconnection (r = -0.32, P = 0.005), whereas five out of six patients without PV reconnection had recurrences within the first 9 months after PVI. CONCLUSIONS: At redo ablation most patients with recurrence of AF after PVAC PVI had PV reconnection(s). Patients with PV reconnection(s) showed a moderate negative correlation between the number of reconnected PVs and the time of AF recurrence with more extensive PV reconnections resulting in earlier PV recurrences after the blanking period. Patients without PV reconnection experienced early AF recurrences, indicating non-PV triggers contribute to AF recurrences in these patients.