Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study

Abstract

[www.ahajournals.org]

[doi.org]

BACKGROUND:

Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study.

METHODS:

Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared.

RESULTS:

Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13–2.23]; P=0.006).

CONCLUSIONS:

In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.

Thank-you! It's a little unsettling to me that the disorder progresses, interventions of a kind notwithstanding. Arial size/volume, fibroids, valve leakage and deterioration, reconnections...geeeeezzz..

That study seems to assume that the pulmonary veins are the only source of afib. They are not. The ones who failed the redo probably have afib sources outside the pulmonary veins so no amount of repeating PVIs will ever help them.

Let's imagine these statements are correct.

Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13–2.23]; P=0.006).

Left atrial size is a significant predictor of ablation outcome in this population.

How does a patient influence that factor? Controlling blood pressure? Avoiding zone 3 and up exercise?

One avoids inducing AF. Or flutter. Both. It's the out-of-sequence and rapid contractions that cause the ventricle to push blood past the aging mitral valve and into the LA, and the double-time contraction of the LA cause hpertrophy.

There are several causes, at least ten of them:

[www.ncbi.nlm.nih.gov]

But yes, BP, fibrillation, ischemic heart disease/stenosis, possibly PV hypertension...all the way from weight gain, high carb intake, metabolic disease, chronic inflammation from celiac disease, arthritis and associated auto-immune poblems,...

Probably the best things to do are to restrict calories...just a wee bit, and certainly forego a lot of the carbs we typically ingest...often in liquid form or with junk 'food'...and to walk several times each week for close to an hour. Or cycle, or row...anything to expend some calories and improve immune response thereby. The literature is increasingly supportive of the two. You want to reduce chronic inflammation, improve the gut biome (no artificial sweeteners!), and lose that spare tire...and a half. BP will come down, bad blood markers like CRP (C-reactive protein) will come down.

Oops...forgot a HUGE one: anyone not outdoor in CA or FL or TX, or who lives anywhere north of those, including half of CA, should be taking about 3000-4000 IU of vitamin D3, and probably best to chase those tablets with Vit K-Mk2... if that won't present other problems to any one individual. Check with your GP. Almost nobody in the western world gets enough vitamin D. It must either be fabricated by the skin (cholecalciferol), or you must ingest it.