ACUTE PULMONARY VEIN RECONNECTION IS A PREDICTOR OF ATRIAL FIBRILLATION RECURRENCE FOLLOWING PULMONARY VEIN ISOLATION
E. Anter, F. Contreras-Valdes, A. Shvilkin, C.M. Tschabrunn, M.E. Josephson
Harvard-Thorndike Electrophysiology Institute Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA, USA
Introduction: The prognostic implications of detection and treatment of acute PV reconnection is not well understood.
Methods: This prospective study included 44 patients (22 men, 60±7 years) who underwent index PVI procedure for treatment of atrial fibrillation (AF). Acute PV reconnection and/or dormant PV Conduction were assessed sequentially in response to a ?30 minute waiting period, intravenous isoproterenol infusion and/or adenosine. All cases of PV reconnection and/or dormant conduction were successfully targeted.
Results: Freedom from AF at 1 year was 75% (83.3% in paroxysmal and 65% in persistent AF, p=ns). AF recurrence was documented in 8/16 patients with acute reconnection, but only in 3/28 patients without acute reconnection group (p=0.009). Three patients underwent a redo procedure, all with previous PV reconnection. In a multivariate analysis, acute PV reconnection was a strong predictor of arrhythmia recurrence (HR 8.3, 95% CI 1.78-39.2).
Conclusions: Identification of acute PV reconnection, even when successfully targeted, is a strong predictor of arrhythmia recurrence following PVI.
Figure 1. The effect of acute pulmonary vein reconnection on AF recurrence
Patient Characteristics
| Variable
| AF-free(n=33)
| AF-recurrence (+)(n=11)
| p-value
|
| Age (year), M ± SE |
59.8 ± 1.1 |
60.6 ± 2.4 |
0.27 |
| Male gender, (%) |
17 (51.5) |
5 (45.5) |
1.00 |
| BMI (kg/m2), M ± SE |
29.1 ± 0.9 |
27.2 ± 0.8 |
0.26 |
| Persistent AF, n, (%) |
13 (39.7) |
7 (63.6) |
0.19 |
| Hypertension, n, (%) |
23 (69.7) |
7 (63.6) |
0.72 |
| Diabetes, n, (%) |
8 (24.2) |
4 (36.4) |
0.46 |
| Coronary Artery Disease, n, (%) |
7 (21.2) |
4 (36.4) |
0.43 |
| LVEF (%),M ± SE |
52.4 ± 1.8 |
52.7 ± 2.1 |
0.93 |
| LA dimension (mm), M ± SE |
49.7 ± 1.2 |
51.4 ± 1.2 |
0.49* |
| OSA, n (%) |
3 (9.4) |
4 (36.4) |
0.06 |
| Acute PV reconnection |
8 (24.2) |
8 (72.7) |
0.009 |
