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. 2025 Mar 25;41(2):e70049.
doi: 10.1002/joa3.70049. eCollection 2025 Apr.

Does organized atrial tachycardia after a pulmonary vein isolation-only procedure portend better outcome of repeat ablation compared to recurrent atrial fibrillation?

Tamás János Riesz  1 , Gábor Bencsik  1 , László Sághy  1 , Róbert Pap  1
Affiliations

Does organized atrial tachycardia after a pulmonary vein isolation-only procedure portend better outcome of repeat ablation compared to recurrent atrial fibrillation?

Tamás János Riesz et al. J Arrhythm. .

Abstract

Background: Better outcome has been suggested for repeat procedures after atrial fibrillation (AF) ablation, when recurrence presented as organized atrial tachycardia (OAT) compared to recurrent AF. However, this contradicts the finding of more advanced atrial remodeling in patients with OAT recurrence and may be related to iatrogenesis by substrate modification during the index procedure. Therefore, we examined the prognostic significance of the type of recurrent arrhythmia after pulmonary vein isolation (PVI) without additional substrate modification.

Methods: We included 185 patients (88 female, 64 ± 9 years) undergoing repeat ablation after index PVI for recurrent OAT (24%) or AF (76%). The recurrence rate, arrhythmia-free survival time, and the type of further recurrences were recorded.

Results: There was no difference in the rate and mean time of arrhythmia-free survival between patients with OAT versus AF recurrence after the first (49% vs. 52%, p = .72 and 51.08 ± 6.66 vs. 53.37 ± 4.75 months, p = .54, respectively) and last (60% vs. 58%, p = .80 and 63.2 ± 7.04 vs. 61.2 ± 5.32 months, p = .23, respectively) redo procedure. AF occurred in the majority of subsequently recurring patients in both groups. No significant difference was found in the outcome of redo procedures between patients with typical flutter and atypical OAT, but a higher rate of successful rhythm control was observed in those with paroxysmal, as compared to persistent AF recurrence.

Conclusion: After a PVI-only index procedure, recurrent OAT is not associated with a better outcome of redo procedures compared to recurrent AF. After repeat ablations, both groups experience AF as the dominant further recurrence.

Keywords: atrial fibrillation; organized atrial tachycardia; pulmonary vein isolation; recurrence.

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Conflict of interest statement

No conflict of interest can be disclosed on behalf of the authors. The authors did not receive support from any organization for the submitted work.

Figures

FIGURE 1
FIGURE 1
Rate of recurrence‐free patients (shaded rectangles) in different groups. AF, atrial fibrillation; OAT, organized atrial tachycardia; PVI, pulmonary vein isolation.
FIGURE 2
FIGURE 2
Recurrence‐free survival after last redo ablation. (A) All patients. (B) Patients with persistent AF at initial PVI. (C) Patients with paroxysmal AF at initial PVI. AF, atrial fibrillation; OAT, organized atrial tachycardia.
See this image and copyright information in PMC

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