The incremental benefit of non-pulmonary vein left atrial ablation in patients undergoing a repeat persistent atrial fibrillation ablation procedure.

Purpose: Atrial fibrillation (AF) recurrence after an initial persistent AF ablation procedure is high, frequently resulting in the need for a repeat AF ablation procedure. Guidance on the optimal strategy for repeat procedures is non-existent. The objective of this study was to compare the freedom from recurrent atrial arrhythmia associated with two strategies for repeat persistent AF ablation procedure: (1) pulmonary vein re-isolation alone and (2) non-pulmonary vein LA ablation in addition to pulmonary vein re-isolation.

Methods: A retrospective multi-center case-controlled study was undertaken. Time-to-recurrent AF with each strategy was assessed using Kaplan-Meier curves. A Cox proportional-hazards regression model was used to determine time-dependent predictors of recurrent AF after the repeat procedure in the entire cohort.

Results: Ninety-eight patients were included in the cohort-39 patients who did not undergo additional LA ablation and 59 patients who had did. AF after the repeat procedure occurred in 38 % of the cohort during a mean follow-up of 18 ± 11 months. Additional LA ablation at the repeat procedure was not associated with a less arrhythmia recurrence (HR = 1.55, p = 0.28). The only variable associated with arrhythmia recurrence after the repeat procedure was additional LA ablation during the initial ablation procedure (HR = 4.13, p = 0.005).

Conclusions: LA ablation in addition to pulmonary vein re-isolation during a repeat persistent AF ablation procedure was not associated with reduced arrhythmia recurrence after a repeat persistent AF ablation procedure.