Objectives: Analyze and compare all recurrences after the first ablation of atrial fibrillation in the long term follow up.
Materials and Methods: We studied long term follow up of 61 patients, mean age 54 + 17 years, who had undergone ablation of an atrial fibrillation (AF) including those with paroxysmal, persistent and long standing persistent AF. All these patients had recurrences after the first procedure. Patients were divided into two groups according to type of arrhythmia before ablation: in the first group patients had lone AF before the procedure; in the second group patients had AF in combination with atrial flutter. Mean follow up period 18 + 11 months.
The aim of the first procedure of atrial fibrillation ablation was the antral isolation of all pulmonary veins (PV). In a case of recurrence of AF the aim of procedure was to reisolate of reconnected PV. If all PV were isolated we completed procedure with vagal denervation.
After the first ablation all recurrences were divided into two subgroups in each group: 1)recurrences in AF and 2)recurrences in atrial flutter (typical or atypical).
Results: In both groups recurrences in AF only we associated with worse prognosis when compared with recurrences in any atrial flutter. It was possible to maintain sinus rhythm in a group of patients with recurrence in AF (36 patients) after multiple procedures (at least three) in 18 cases 50%. In a group of patients with recurrences in any atrial flutter (25 patients) it was possible to maintain sinus rhythm after multiple procedures (at least two) in 24 patients 96%.
At the end of the study in the first group of patients with isolated AF before ablation (42 patients) sinus rhythm was present in 26 patients 62%, 9 patients got pacemaker and AV node ablation 21,4% and 6 patients 16,6% were on pharmacological rate control therapy.
In a group of patients who presented with AF in combination with atrial flutter before ablation (19 patients) sinus rhythm was maintained in 16 patients 84,2%, 3 patients 15,8% were on pharmacological rate control therapy.
Conclusions: Recurrence in any type of macroreentrant supraventricular tachycardia after the first ablation of atrial fibrillation seems to have the best prognosis on long term results and on sinus rhythm maintenance when compared with AF as a recurrence after ablation. Those patients who have AF in combination with atrial flutter before ablation have best prognosis when compared with patients who have lone AF.