Ablation strategy and the number of repeat procedures not associated with atrial fibrillation recurrence

Ablation strategy and the number of re-ablation strategies are not statistically significantly associated with atrial fibrillation recurrence based on real-world data from the Netherlands.

Mr Federico Tancredi Magni (University Medical Center Groningen, the Netherlands) and colleagues analysed ablation strategies applied in patients with isolated pulmonary veins using data from all patients with repeat atrial fibrillation ablation recorded in the Netherlands Heart Registration [1]. Patients were included if they had atrial fibrillation with all pulmonary veins isolated during electrophysiologic mapping and were excluded if they had prior surgical ablation outside of the pulmonary veins or if re-ablation was due to atrial flutter or tachycardia. The analysis included a total of 274 patients.

The most common ablation strategy was posterior wall ablation (58.4%) followed by pulmonary vein antrum isolation (26.3%). A total of 12% of patients received no further ablation once durable pulmonary vein isolation was confirmed, while 41.2% of patients received an additional strategy, 32.1% of patients received 2 additional strategies, and 12.8% of patients had 3 additional strategies.

Over a follow-up of 2 years, 59.8% of patients had an atrial fibrillation recurrence and 12.7% of patients required re-ablation within the first year following their initial procedure. A multivariate adjusted analysis showed no association between the ablation strategy type and differences in atrial fibrillation occurrence. Furthermore, no statistically significant differences were seen in atrial fibrillation strategy, individual strategy as well as persistent atrial fibrillation; however, a higher risk of atrial fibrillation recurrence was seen in patients with a larger left atrium (HR 1.03; 95% CI 1.01–1.05).

In summary, in this cohort from the Netherlands Heart Registration, posterior wall ablation was the most commonly used ablation strategy. However, the atrial fibrillation recurrence rates were not associated with a particular ablation strategy or the number of strategies.

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   1. Magni FT, et al. A multicenter evaluation of repeat ablation for atrial fibrillation in patients with isolated pulmonary veins: a Netherlands Heart Registration study. Atrial fibrillation: ablation 2,. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202429 April 2024