Predictors of atrial fibrillation recurrence despite successful pulmonary vein isolation

Abstract

BACKGROUND: Pulmonary vein isolation (PVI) for curative treatment of atrial fibrillation (AF) most commonly fails because of pulmonary vein electrical reconnection. However, sometimes procedures are unsuccessful despite successful persistent isolation of the veins. OBJECTIVES: The purpose of this study was to identify baseline predictors of this latter group. This would allow better case selection for PVI procedures. METHODS: We considered baseline characteristics of two groups of patients at Westmead Public Hospital, Sydney, NSW, after successful single ring PVI was conducted between 2017-2020 (n=172). Patients were followed longitudinally after their first ablation procedure. The average age for the whole group was 63.2 years +/- 11.0, and 58% had persistent/longstanding persistent AF. Group A (n=17) had clinical recurrence of AF and were found to have isolated pulmonary veins at a subsequent procedure, whilst Group B (n=87) had no clinical recurrence of AF after the initial procedure. This means that 10% of patients presenting for PVI still had AF despite successful PVI. RESULTS: Patients with recurrence of atrial fibrillation with isolated pulmonary veins were older than those without recurrence and had a longer duration of AF symptoms prior to their index ablation procedure (Table). There were no significant differences in gender, BMI, hypertension, diabetes, cardiac disease, stroke, type of AF, body surface area (BSA) and LA volume. CONCLUSIONS: Thus, patients who present with AF recurrence despite sustained PVI are older and have a longer duration of AF compared to patients who do not have AF recurrence following successful PVI. Better characterisation of this group may assist with case selection.