Very late relapse of atrial fibrillation after pulmonary vein isolation: incidence and results of repeat ablation.

Background: There are few data about the incidence of very late (>12 months) arrhythmia relapse after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and about the success rate of repeat ablation procedures in this population.

Methods: All patients treated with PVI for paroxysmal AF were screened in the institution's electrophysiology database. Follow-up data at 1, 3, 6, and 12 months and yearly thereafter including repetitive (7 days or 1 day) Holter electrocardiograms were assessed as well as the technique and success rate of repeat ablations.

Results: Overall, 24 of 356 (6.7%) patients experienced their first AF recurrence more than 12 months after PVI. Of these 24 patients, 14 underwent reablation for paroxysmal (11 patients) or persistent AF (three patients). Repeat ablation included re-PVI in all 14 patients (43 of 48 initially isolated PVs with recovered left atrial-PV conduction). Ablation of complex fractionated atrial electrograms or left/right atrial lines was performed in eight patients, including the three patients with persistent AF. During follow-up of 15.1 ± 9 months after the second ablation, 10 of 14 (71%) reablated patients remained in sinus rhythm.

Conclusions: After PVI for paroxysmal AF, very late arrhythmia recurrence occurs in less than 10% of patients. The success rate of the repeat procedure is high.