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Predictors and Characteristics of Multiple (More Than 2) Catheter Ablation Procedures for Atrial Fibrillation
Li-Wei Lo1,2, Yenn-Jiang Lin1,2, Shih-Lin Chang1,2
1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Recurrent atrial fibrillation (AF) after catheter ablation may require repeat procedures. Non-pulmonary vein triggers identified during the initial ablation predict the need for multiple AF ablation treatments.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) recurrence is common post-catheter ablation.
- Evaluating patient characteristics for multiple ablations is crucial.
Purpose of the Study:
- To identify predictors for undergoing multiple (>2) catheter ablation procedures for AF.
- To characterize patients requiring repeat AF ablation interventions.
Main Methods:
- Retrospective analysis of 666 AF patients undergoing catheter ablation.
- Investigated baseline and procedural factors impacting the need for multiple ablations.
- Multivariate analysis identified independent predictors of repeat procedures.
Main Results:
- 8% of patients (52/666) underwent more than two ablation procedures.
- Non-pulmonary vein (PV) triggers at index ablation independently predicted the need for multiple procedures (OR 2.69).
- Ligament of Marshall triggers predicted multiple procedures in non-PV trigger patients (OR 6.74).
Conclusions:
- Non-PV ectopic beats initiating AF at the index procedure predict the need for multiple ablations.
- Pulmonary vein-initiated AF remains a significant cause of recurrence despite repeat procedures.
Background:
The recurrence of atrial fibrillation (AF) is not uncommon in the era of catheter ablation. This study aimed to evaluate the characteristics of AF patients who underwent multiple (>2) ablation procedures.
Methods And Results:
Of 666 consecutive patients (53 ± 11 y/o, 484 men) who underwent catheter ablation of AF (paroxysmal AF, n = 530), 144 (22%) underwent 2 procedures and 52 (8%) underwent more than 2 procedures due to symptomatic recurrences refractory to medication during 48 ± 23 months of follow-up. Baseline and procedural characteristics at the index procedure were investigated to determine their impact on the necessity of multiple procedures. After 2 procedures, 48 (92%) of 52 patients had pulmonary vein (PV) ectopic beats initiating AF. Coexisting PV and non-PV triggers were found in 23 of 48 patients. In a multivariate analysis, the presence of non-PV triggers (P = 0.004; odds ratio 2.69, 95% CI 1.37-5.28) at the index procedure was the only independent predictor of necessary multiple procedures. Among patients with non-PV ectopic beats initiating AF at the index procedure, the presence of ligament of Marshall triggers (P = 0.001, odds ratio 6.74, 95% CI 2.13-21.32) could predict the necessity of multiple procedures.
Conclusions:
The need for multiple catheter ablation procedures can be predicted by the presence of non-PV ectopic beats initiating AF at the index procedure. However, PV-initiated AF remains the major cause of AF recurrence despite multiple catheter ablation procedures.
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