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Pulmonary vein reconnection no longer occurs in the majority of patients after a single pulmonary vein isolation procedure

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Abstract
OBJECTIVES This study sought to determine the prevalence of patients with 4 isolated veins at repeat ablation after "CLOSE" -guided pulmonary vein isolation (PVI), a strategy based on delivery of contiguous and optimized radiofrequency lesions. BACKGROUND The likelihood of finding 4 isolated veins at a repeat ablation for atrial fibrillation (AF) recurrence after a first PVI is low. METHODS Patients undergoing repeat ablation for AF recurrence after first CLOSE-guided PVI were included. At repeat: 1) the status of the PV was evaluated; and 2) high-density voltage mapping was performed. In case of pulmonary vein reconnection (PVR), veins were reisolated. In patients with 4 isolated veins, empirical trigger or substrate ablation was performed. RESULTS Of 326 patients undergoing CLOSE-guided PVI for paroxysmal AF, 45 patients underwent repeat ablation for AF recurrence (11 +/- 7 months after first PVI). In 28 patients, all veins were still isolated (62%). They showed similar clinical characteristics and similar time from first PVI to AF recurrence (8 +/- 7 vs. 6 +/- 6 months, respectively, p = 0.453) compared with patients with PVR. In contrast, they were characterized by a higher incidence of low voltage (57% vs. 17%, p = 0.033). Patients with 4 isolated veins, compared with patients treated for PVR, showed a lower 12-month freedom from AF after repeat ablation (61% vs. 88%, p = 0.045). CONCLUSIONS After CLOSE-guided ablation, PVR is no longer the rule in patients with AF recurrence. Patients with AF recurrence and 4 isolated veins present with a similar clinical profile and time to recurrence as patients with PVR. (C) 2019 by the American College of Cardiology Foundation.
Keywords
Cardiology, Cardiovascular Medicine, atrial fibrillation, pulmonary vein isolation, pulmonary vein reconnection, radiofrequency, PAROXYSMAL ATRIAL-FIBRILLATION, SUPERIOR VENA-CAVA, CATHETER ABLATION, 2ND-GENERATION CRYOBALLOON, RADIOFREQUENCY LESIONS, ANTRUM ISOLATION, CHADS(2) SCORE, CONDUCTION, RECURRENCE, RESUMPTION

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MLA
De Pooter, Jan, et al. “Pulmonary Vein Reconnection No Longer Occurs in the Majority of Patients after a Single Pulmonary Vein Isolation Procedure.” JACC. CLINICAL ELECTROPHYSIOLOGY, vol. 5, no. 3, 2019, pp. 295–305, doi:10.1016/j.jacep.2018.11.020.
APA
De Pooter, J., Strisciuglio, T., El Haddad, M., Wolf, M., Phlips, T., Vandekerckhove, Y., … Duytschaever, M. (2019). Pulmonary vein reconnection no longer occurs in the majority of patients after a single pulmonary vein isolation procedure. JACC. CLINICAL ELECTROPHYSIOLOGY, 5(3), 295–305. https://doi.org/10.1016/j.jacep.2018.11.020
Chicago author-date
De Pooter, Jan, Teresa Strisciuglio, Milad El Haddad, Michael Wolf, Thomas Phlips, Yves Vandekerckhove, René Tavernier, Sebastien Knecht, and Mattias Duytschaever. 2019. “Pulmonary Vein Reconnection No Longer Occurs in the Majority of Patients after a Single Pulmonary Vein Isolation Procedure.” JACC. CLINICAL ELECTROPHYSIOLOGY 5 (3): 295–305. https://doi.org/10.1016/j.jacep.2018.11.020.
Chicago author-date (all authors)
De Pooter, Jan, Teresa Strisciuglio, Milad El Haddad, Michael Wolf, Thomas Phlips, Yves Vandekerckhove, René Tavernier, Sebastien Knecht, and Mattias Duytschaever. 2019. “Pulmonary Vein Reconnection No Longer Occurs in the Majority of Patients after a Single Pulmonary Vein Isolation Procedure.” JACC. CLINICAL ELECTROPHYSIOLOGY 5 (3): 295–305. doi:10.1016/j.jacep.2018.11.020.
Vancouver
1.
De Pooter J, Strisciuglio T, El Haddad M, Wolf M, Phlips T, Vandekerckhove Y, et al. Pulmonary vein reconnection no longer occurs in the majority of patients after a single pulmonary vein isolation procedure. JACC CLINICAL ELECTROPHYSIOLOGY. 2019;5(3):295–305.
IEEE
[1]
J. De Pooter et al., “Pulmonary vein reconnection no longer occurs in the majority of patients after a single pulmonary vein isolation procedure,” JACC. CLINICAL ELECTROPHYSIOLOGY, vol. 5, no. 3, pp. 295–305, 2019.
@article{8615679,
  abstract     = {{OBJECTIVES This study sought to determine the prevalence of patients with 4 isolated veins at repeat ablation after "CLOSE" -guided pulmonary vein isolation (PVI), a strategy based on delivery of contiguous and optimized radiofrequency lesions.

BACKGROUND The likelihood of finding 4 isolated veins at a repeat ablation for atrial fibrillation (AF) recurrence after a first PVI is low.

METHODS Patients undergoing repeat ablation for AF recurrence after first CLOSE-guided PVI were included. At repeat: 1) the status of the PV was evaluated; and 2) high-density voltage mapping was performed. In case of pulmonary vein reconnection (PVR), veins were reisolated. In patients with 4 isolated veins, empirical trigger or substrate ablation was performed.

RESULTS Of 326 patients undergoing CLOSE-guided PVI for paroxysmal AF, 45 patients underwent repeat ablation for AF recurrence (11 +/- 7 months after first PVI). In 28 patients, all veins were still isolated (62%). They showed similar clinical characteristics and similar time from first PVI to AF recurrence (8 +/- 7 vs. 6 +/- 6 months, respectively, p = 0.453) compared with patients with PVR. In contrast, they were characterized by a higher incidence of low voltage (57% vs. 17%, p = 0.033). Patients with 4 isolated veins, compared with patients treated for PVR, showed a lower 12-month freedom from AF after repeat ablation (61% vs. 88%, p = 0.045).

CONCLUSIONS After CLOSE-guided ablation, PVR is no longer the rule in patients with AF recurrence. Patients with AF recurrence and 4 isolated veins present with a similar clinical profile and time to recurrence as patients with PVR. (C) 2019 by the American College of Cardiology Foundation.}},
  author       = {{De Pooter, Jan and Strisciuglio, Teresa and El Haddad, Milad and Wolf, Michael and Phlips, Thomas and Vandekerckhove, Yves and Tavernier, René and Knecht, Sebastien and Duytschaever, Mattias}},
  issn         = {{2405-500X}},
  journal      = {{JACC. CLINICAL ELECTROPHYSIOLOGY}},
  keywords     = {{Cardiology,Cardiovascular Medicine,atrial fibrillation,pulmonary vein isolation,pulmonary vein reconnection,radiofrequency,PAROXYSMAL ATRIAL-FIBRILLATION,SUPERIOR VENA-CAVA,CATHETER ABLATION,2ND-GENERATION CRYOBALLOON,RADIOFREQUENCY LESIONS,ANTRUM ISOLATION,CHADS(2) SCORE,CONDUCTION,RECURRENCE,RESUMPTION}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{295--305}},
  title        = {{Pulmonary vein reconnection no longer occurs in the majority of patients after a single pulmonary vein isolation procedure}},
  url          = {{http://dx.doi.org/10.1016/j.jacep.2018.11.020}},
  volume       = {{5}},
  year         = {{2019}},
}

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