Outcomes And Clinical And Electrophysiological Characteristics Predicting The Recurrence Of Atrial Fibrillation During The 12 Months Follow-up After The Second Ablation

Background and objective Though catheter ablation has been a therapeutic treatment strategy for atrial fibrillation(AF)for more than one decade,recurrence of atrial arrhythmias after ablation is not a rarely encountered condition.[1-5] To date,there is a paucity of data dedicatedly investigated the relationship between the clinical and electrophysiological characterization and re-ablation outcome for the recurrent AF patients.This study was to report the re-ablation outcome for patients with atrial fibrillation and further to characterize the clinical and electrophysiological feature of the patients with recurrence post the re-ablation.Methods From January 2012 to May 2017,the patients underwent re-ablation for AF in our hospital were consecutively enrolled.The clinical and electrophysiological data for the initial and redo procedure,gender,age,BMI,AF history duration,AF type,hypertension,diabetes,coronary artery disease,LAD,LVDd,LVEF,substrate ablation,non-PV trigger,failed ablation of non-PV trigger,time to recurrence after initial ablation,recurrence type,PV reconnection,CTI ablation,SVC isolation,were collected retrospectively and prospectively,respectively,The patients were followed up for one year and the recurrences during the time were reported.Results Totally 2864 patients accepted ablation for AF in our hospital from January 2012 to May 2017.A total of 325 consecutive patients referred for re-ablation for recurrence of AF after first ablation.Among them,those patients who had their first ablation performed in the other center(n=19),patients who had their first procedure done with cryoablation(n=13)or surgical ablation(n=4)and patients who were out of follow up(n=30)was excluded from the analysis.Totally 259 patients entered into the analysis(age 58.4±10.5 years;169 men;124 paroxysmal AF).At the end of one-year follow-up,a total of 85 patients(32.8%)recurred with atrial fibrillation or atrial tachycardia after the re-ablation.In the multivariate analysis,higher CHA2DS2-VASC score(p=0.023,95% CI 1.03-1.53),shorter time to recurrence after the initial ablation(p=0.001,95% CI 0.93-0.98)were clinical factors predictive of one-year recurrence after the repeat ablation.The reconnection of the right pulmonary vein(PV)(p=0.034,95% CI 0.31-0.96)and the absence of not eliminated non-PV trigger at the second procedure(p=0.032,95% CI 1.25-142.80)independently predicted the better re-ablation outcome.Conclusions About one thirds of patients had recurrence during one year of follow-up post the repeat ablation.The CHA2DS2-VASC score and the time to recurrence after the initial ablation were the independent clinical factors predicting the recurrence during the one year of follow-up after the second ablation.Also,electrophysiological findings during the repeat ablation(the right PV reconnection and absence of not eliminated non-PV trigger)were associated with better outcome during one-year of follow-up.