Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Cardiovasc Electrophysiol. 2021 Mar;32(3):628-638. doi: 10.1111/jce.14867. Epub 2021 Feb 15.
Atrial fibrillation (AF) ablation is successful in 60%-80% of optimal candidates, with many patients requiring repeat procedures. We performed a detailed examination of electrophysiologic findings and clinical outcomes associated with first repeat AF ablations in the era of contact force-sensing radiofrequency (RF) catheters.
We retrospectively studied patients who underwent their first repeat AF ablations for symptomatic, recurrent AF at our center between 2013 and 2019. All repeat ablations were performed using contact force-sensing RF catheters. Pulmonary vein (PV) reconnections at repeat ablation and freedom from atrial arrhythmia 1 year after repeat ablation were evaluated. We further assessed these findings based on AF classification at the time of presentation for repeat ablation, index RF versus cryoballoon (CB) ablation, and duration (≥3 versus <3 years) between index and repeat procedures.
Among 300 patients, there were 136 (45.3%) who presented for their first repeat ablations in persistent AF. During repeat ablation, at least one PV reconnection was found in 257 (85.6%) patients, while 159 (53%) had three to four reconnections. There was a similar distribution of reconnections among patients with persistent versus paroxysmal AF (mean: 2.7 ± 1.3 vs. 2.9 ± 1.2; p = .341), index RF versus CB ablation (mean: 2.8 ± 1.3 vs. 2.9 ± 1.2; p = .553), and ≥3 versus <3 years between index and repeat procedures (mean: 3.0 ± 1.1 vs. 2.7 ± 1.3; p = .119). At repeat ablation, the PVs were re-isolated in all patients, and additional non-PV ablation was performed in 171 (57%) patients. Freedom from atrial arrhythmia at 1-year follow-up after repeat ablation was 66%, similar among those with persistent versus paroxysmal AF (65.4% vs. 66.5%; p = .720), index RF versus CB ablation (66.7% vs. 68.9%; p = .930), and ≥3 versus <3 years between index and repeat ablations (64.4% vs. 66.7%; p = .760). Major complications occurred in a total of 4 (1.3%) patients.
In a contemporary cohort of patients receiving their first repeat AF ablations using contact force-sensing RF catheters, PV reconnections were common, and freedom from atrial arrhythmia was 66% at 1-year follow-up. The distributions of PV reconnections and rates of freedom from atrial arrhythmia were similar, based on persistent versus paroxysmal AF at presentation for repeat ablation, index RF versus CB ablation, and duration between index and repeat procedures. The incidence of major complications was very low.
在最佳候选人群中，房颤（AF）消融成功率为 60%-80%，许多患者需要重复手术。我们对使用接触力感应射频（RF）导管进行首次重复 AF 消融的电生理发现和临床结果进行了详细检查。
我们回顾性研究了 2013 年至 2019 年期间在我们中心因症状性、复发性 AF 而接受首次重复 AF 消融的患者。所有重复消融均使用接触力感应 RF 导管进行。评估重复消融时肺静脉（PV）再连接和重复消融后 1 年无房性心律失常的情况。我们还根据重复消融时 AF 的分类、指数 RF 与冷冻球囊（CB）消融、以及指数与重复手术之间的时间（≥3 年与＜3 年），进一步评估了这些发现。
在 300 例患者中，有 136 例（45.3%）在持续性 AF 时首次接受重复消融。在重复消融时，257 例（85.6%）患者至少发现一处 PV 再连接，159 例（53%）有 3 至 4 处再连接。在持续性与阵发性 AF 患者中，再连接的分布相似（平均：2.7±1.3 比 2.9±1.2；p=0.341），指数 RF 与 CB 消融（平均：2.8±1.3 比 2.9±1.2；p=0.553），以及指数与重复手术之间的时间（≥3 年与＜3 年）（平均：3.0±1.1 比 2.7±1.3；p=0.119）。在重复消融时，所有患者的 PV 均被重新隔离，171 例（57%）患者进行了额外的非 PV 消融。重复消融后 1 年的无房性心律失常率为 66%，在持续性与阵发性 AF 患者中相似（65.4%比 66.5%；p=0.720），指数 RF 与 CB 消融（66.7%比 68.9%；p=0.930），以及指数与重复手术之间的时间（64.4%比 66.7%；p=0.760）。共有 4 例（1.3%）患者发生严重并发症。
在使用接触力感应 RF 导管接受首次重复 AF 消融的当代患者队列中，PV 再连接很常见，重复消融后 1 年的无房性心律失常率为 66%。根据重复消融时的持续性与阵发性 AF、指数 RF 与 CB 消融以及指数与重复手术之间的时间，PV 再连接和无房性心律失常的发生率分布相似。严重并发症的发生率非常低。
