Recurrent arrhythmias after catheter ablation of originally paroxysmal atrial fibrillation and results of repeat ablation

Authors: M. Fiala;  J. Chovančík;  R. Moravec;  D. Wojnarová;  H. Szymeczek;  R. Neuwirth;  R. Nevřalová;  O. Jiravský;  J. Januška;  L. Škňouřil;  M. Dorda;  J. Indrák;  J. Černý;  I. Nykl;  M. Branny
Authors‘ workplace: Oddělení kardiologie, Kardiocentrum, Nemocnice Podlesí, a. s., Třinec, přednosta prim. MUDr. Marian Branny
Published in: Vnitř Lék 2007; 53(12): 1248-1254
Category: Original Contributions


The aim is a description of the recurrent arrhythmias after previous ablation of paroxysmal atrial fibrillation (AF), and the results of a repeat catheter ablation.

A repeat ablation was performed in 76 patients (18 females, 54 ± 11 years) in 96 procedures, which was 21 % out of 362 patients, who had undergone the first ablation for a paroxysmal AF. The endpoints of the repeat ablation were re-isolation of the pulmonary veins (PV) and termination of a spontaneous or induced arrhythmia and restoration of a stable sinus rhythm (SR), and possibly achievement of noninducibility of any arrhythmia.

Clinical left atrial tachycardia (LAT) was present in 10 (13 %) patients before the first, and in 5 (25 %) patients before the second repeat ablation. Arrhythmia arising from an arrhythmogenic PV due to the conduction recovery into the left atrium (LA) was found in 50 (66 %) patients during the first, and in 7 (35 %) patients during the second repeat ablation. Arrhythmias, predominantly of the reentry mechanism and originating in the LA free wall, were found in 26 (34 %), respectively 13 (65 %) during the first or the second repeat ablation. All arrhythmias from PVs were terminated by a PV encircling ablation. Substrate-related arrhythmias were terminated by ablation except for 2 (3 %) patients during the first and 3 (15 %) patients during the second repeat ablation. Persistent AF was mainly terminated via conversion into a LAT. In these cases, the ablation sites leading to the SR restoration were, similarly to the primary LATs, located predominantly in the LA anterior wall. During the 22 ± 13 months follow-up, 68 (89 %) patients were free of AF, 54 (71 %) patients off the antiarrhythmic drugs and 14 (18 %) patients with the class I or III antiarrhythmic drugs.

AF associated with PV-LA re-connection dominated prior to the first repeat ablation, then the proportion of the substrate-related arrhythmias from the LA free wall increased. Clinical efficacy of the repeat ablation is high.

Key words:
atrial fibrillation – catheter ablation – recurrent arrhythmias – repeat ablation


1. Cappato R, Negroni S, Pecora D et al. Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation 2003; 108: 1599-1604.

2. Chung A, Oral H, Good E et al. Catheter ablation of atypical atrial flutter and atrial tachycardia within the coronary sinus after left atrial ablation for atrial fibrillation. J Am Coll Cardiol 2005; 46: 83-91.

3. Daoud EG, Weiss R, Augostini R et al. Proarrhythmia of circumferential left atrial lesion for management of atrial fibrillation. J Cardiovasc Electrophysiol 2006; 17: 157-165.

4. Fiala M, Chovančík J, Heinc P et al. Léčba symptomatické intermitentní fibrilace síní katetrovou ablací v levé srdeční síni: bezprostřední a dlouhodobé výsledky u 150 pacientů. Vnitř Lék 2005; 51: 971-983

5. Fiala M, Chovančík J, Neuwirth R et al. Katetrová ablace pro chronickou fibrilaci síní metodou obkružujících a komplexních lineárních lézí v levé srdeční síni: ukončení arytmie při ablaci a dlouhodobé klinické výsledky. Vnitř Lék 2007; 3: 231-241.

6. Fiala M, Chovančík J, Neuwirth R et al. Atrial macroreentry tachycardia in patients without obvious structural heart disease or previous cardiac surgical or catheter intervention: characterization of arrhythmogenic substrates, reentry circuits, and results of catheter ablation. J Cardiovasc Electrophysiol 2007; 18: 824-832.

7. Gerstenfeld EP, Callans DJ, Dixit S et al. Mechanism of organized left atrial tachycardias occurring after pulmonary vein isolation. Circulation 2004; 110: 1351-1357.

8. Gerstenfeld EP, Marchlinski FE Mapping and ablation of left atrial tachycardias occurring after atrial fibrillation ablation. Heart Rhythm. 2007; 4(Suppl.): S65-S72.

9. Haïssaguerre M, Jaïs P, Shah DC et al. Electrophysiological endpoint for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000; 101: 1409-1417.

10. Haïssaguerre M, Hocini M, Sanders P et al. Localized sources maintaining atrial fibrillation organized by prior ablation. Circulation 2006; 113: 616-625.

11. Haïsssaguerre M, Sanders P, Hocini M et al. Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination. J Cardiovasc Electrophysiol 2005; 16: 1125-1137.

12. Hsieh MH, Tai CT, Tsai CF et al. Clinical outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2003; 14: 598-601.

13. Hsu LF, Jaïs P, Keane D et al. Atrial fibrillation originating from the persistent left superior vena cava. Circulation 2004; 109; 828-832.

14. Jaïs P, Hocini M, Sanders P et al. Long-term evaluation of atrial fibrillation ablation guided by noninducibility. Heart Rhythm 2006; 3: 140-145.

15. Jaïs P, Sanders P, Hsu LF et al. Flutter localized to the anterior left atrium after catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2006; 17: 279-285.

16. Kamanu S, Tan AY, Peter CT et al. Vein of Marshall activity during sustained atrial fibrillation. J Cardiovasc Electrophysiol 2006; 17: 839-846.

17. Lemola K, Hall B, Cheung P et al. Mechanisms of recurrent atrial fibrillation after pulmonary vein isolation by segmental ostial ablation. Heart Rhythm 2004; 1: 197-202.

18. Ouyang F, Antz M, Ernst S et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons form the double Lasso technique. Circulation 2005; 111: 127-135.

19. Ouyang F, Bänsch D, Ernst S et al. Complete isolation of the left atrium surrounding the pulmonary veins: new insights from the double-lasso technique in paroxysmal atrial fibrillation. Circulation 2004; 110: 2090-2096.

20. Pappone C, Oreto G, Rosanio S et al. Atrial electroanatomic remodelling after circumferential radiofrequency pulmonary vein ablation. Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104: 2539-2544.

21. Pappone C, Manguso F, Vicedomini G et al. Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation. Circulation 2004; 110: 3036-3042.

22. Shah DC, Sunthorn H, Burri H et al. Narrow, slow-conducting isthmus dependent left atrial reentry developing after ablation of atrial fibrillation: ECG characterization and elimination by focal ablation. J Cardiovasc Electrophysiol 2006; 17: 508-515.

23. Tsai CF, Tai CT, Hsieh MH et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava. Circulation 2000; 102: 67-74.

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