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CLINICAL STUDY

Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation

Hakan Oral, MD, FACC^*,*, Bradley P. Knight, MD, FACC^*, Mehmet Özaydn, MD^*, Hiroshi Tada, MD^*, Aman Chugh, MD^*, Sohail Hassan, MD^*, Christoph Scharf, MD^*, Steve W. K. Lai, MD^*, Radmira Greenstein, MD^*, Frank Pelosi, Jr, MD, FACC^*, S. Adam Strickberger, MD, FACC^* and Fred Morady, MD, FACC^*

^* Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

Manuscript received February 18, 2002; revised manuscript received April 1, 2002, accepted April 10, 2002.

^* Reprint requests and correspondence: Dr. Hakan Oral, Cardiology, B1F245, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0022, USA.
oralh{at}umich.edu

OBJECTIVES: The purposes of this study were to describe the prevalence of early recurrences of atrial fibrillation (ERAF) that occur within two weeks after pulmonary vein (PV) isolation, and to determine whether ERAF is predictive of long-term outcome after PV isolation.

BACKGROUND: Atrial fibrillation (AF) sometimes recurs within days after PV isolation and may prompt an early repeat intervention.

METHODS: Segmental PV isolation was performed using radiofrequency energy in 110 consecutive patients (mean age 53 ± 11 years) with paroxysmal (93 patients) or persistent (17 patients) AF. Three to four PVs were targeted for isolation in all patients. Pulmonary vein isolation was complete in 338 of the 358 PVs that were targeted (94%).

RESULTS: Early recurrences of AF occurred in 39 of 110 patients (35%) at a mean of 3.7 ± 3.5 days after the procedure. The prevalence of ERAF was similar in patients with paroxysmal and persistent AF (33% and 47%, respectively, p = 0.4). Beyond the first two weeks, at 208 ± 125 days of follow-up, 60 of the 71 patients without ERAF (85%) and 12 of the 39 patients with ERAF (31%) were free of recurrent AF in the absence of antiarrhythmic drug therapy (p < 0.001).

CONCLUSIONS: Early recurrences of AF occur in approximately 35% of patients within two weeks after isolation of three to four PVs, and are associated with a lower long-term success rate than in patients without ERAF. However, approximately 30% of patients with ERAF have no further symptomatic AF during long-term follow-up. Therefore, temporary antiarrhythmic drug therapy may be more appropriate than early repeat ablation in patients with ERAF.

Abbreviations and Acronyms   AF   atrial fibrillation   ERAF   early recurrence of atrial fibrillation   LVEF   left ventricular ejection fraction   PV   pulmonary vein   RF   radiofrequency

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