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. 2021 Aug;61(2):227-234.
doi: 10.1007/s10840-020-00795-x. Epub 2020 Jun 16.

Acute and long-term outcome of redo catheter ablation for recurrent atrial tachycardia and recurrent atrial fibrillation in patients with prior atrial fibrillation ablation

Young Choi  1 , Sunhwa Kim  1 , Ju Yeol Baek  1 , Sung-Hwan Kim  1 , Ju Youn Kim  2 , Tae-Seok Kim  3 , Youmi Hwang  4 , Ji-Hoon Kim  4 , Sung-Won Jang  5 , Man Young Lee  6 , Yong-Seog Oh  7
Affiliations

Acute and long-term outcome of redo catheter ablation for recurrent atrial tachycardia and recurrent atrial fibrillation in patients with prior atrial fibrillation ablation

Young Choi et al. J Interv Card Electrophysiol. 2021 Aug.

Abstract

Purpose: Organized atrial tachycardia (AT) accounts for a substantial proportion of recurrence after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We sought to analyze the characteristics and long-term outcome of redo RFCA for recurrent AT compared with those for recurrent AF.

Methods: We analyzed 133 patients who underwent prior AF ablation and presented for redo RFCA procedure. Documented rhythm at recurrence was AT in 50 patients (37.6%) and AF in 83 patients (62.4%). Redo ablation was conducted using a stepwise approach in all subjects.

Results: Recurrent arrhythmia was more frequently a persistent type in the AT group (70.0% vs. 36.1% in the AT and AF group, respectively, p < 0.001). Fifty mappable ATs were identified in the AT group. Perimitral reentry was most common (19/50), followed by PV-related focal or reentrant tachycardia (16/50). During the redo RFCA, PV reconnection rate and linear ablation rate were similar in the two groups, while the focal target ablation tended to be conducted more frequently in the AF group (26.0% vs. 42.2%, p = 0.060). The AT group showed a higher acute success rate (92.0% vs. 75.9%, p = 0.019) and higher arrhythmia freedom during a mean of 30 months (76.0% vs. 55.4%, p = 0.030), compared with the AF group. The AT group and de novo AF type (paroxysmal) were independent predictors for higher arrhythmia freedom.

Conclusions: RFCA for recurrent AT following AF ablation showed favorable acute and long-term success rates and was associated with superior procedural outcomes compared with those for recurrent AF.

Keywords: Atrial fibrillation; Atrial flutter; Atrial tachycardia; Radiofrequency catheter ablation.

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