Vnitr Lek 2007, 53(12):1248-1254

Recurrent arrhythmias after catheter ablation of originally paroxysmal atrial fibrillation and results of repeat ablation

M. Fiala^*, J. Chovančík, R. Moravec, D. Wojnarová, H. Szymeczek, R. Neuwirth, R. Nevřalová, O. Jiravský, J. Januška, L. Škňouřil, M. Dorda, J. Indrák, J. Černý, I. Nykl, M. Branny

Oddělení kardiologie, Kardiocentrum, Nemocnice Podlesí, a.s., Třinec, přednosta prim. MUDr. Marian Branny

Aims:
The aim is a description of the recurrent arrhythmias after previous ablation of paroxysmal atrial fibrillation (AF), and the results of a repeat catheter ablation.

Methods:
A repeat ablation was performed in 76 patients (18 females, 54 ± 11 years) in 96 procedures, which was 21 % out of 362 patients, who had undergone the first ablation for a paroxysmal AF. The endpoints of the repeat ablation were re-isolation of the pulmonary veins (PV) and termination of a spontaneous or induced arrhythmia and restoration of a stable sinus rhythm (SR), and possibly achievement of noninducibility of any arrhythmia.

Results:
Clinical left atrial tachycardia (LAT) was present in 10 (13 %) patients before the first, and in 5 (25 %) patients before the second repeat ablation. Arrhythmia arising from an arrhythmogenic PV due to the conduction recovery into the left atrium (LA) was found in 50 (66 %) patients during the first, and in 7 (35 %) patients during the second repeat ablation. Arrhythmias, predominantly of the reentry mechanism and originating in the LA free wall, were found in 26 (34 %), respectively 13 (65 %) during the first or the second repeat ablation. All arrhythmias from PVs were terminated by a PV encircling ablation. Substrate-related arrhythmias were terminated by ablation except for 2 (3 %) patients during the first and 3 (15 %) patients during the second repeat ablation. Persistent AF was mainly terminated via conversion into a LAT. In these cases, the ablation sites leading to the SR restoration were, similarly to the primary LATs, located predominantly in the LA anterior wall. During the 22 ± 13 months follow-up, 68 (89 %) patients were free of AF, 54 (71 %) patients off the antiarrhythmic drugs and 14 (18 %) patients with the class I or III antiarrhythmic drugs.

Conclusion:
AF associated with PV-LA re-connection dominated prior to the first repeat ablation, then the proportion of the substrate-related arrhythmias from the LA free wall increased. Clinical efficacy of the repeat ablation is high.

Keywords: atrial fibrillation; catheter ablation; recurrent arrhythmias; repeat ablation

Received: May 31, 2007; Accepted: August 9, 2007; Published: December 1, 2007  Show citation