AUTHOR=Gu Zhoushan , Yang Gang , Ju Weizhu , Li Mingfang , Chen Hongwu , Gu Kai , Liu Hailei , Chen Minglong 

TITLE=Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1049414

DOI=10.3389/fcvm.2022.1049414

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Pulmonary vein isolation (PVI) is the standard ablation strategy for treating atrial fibrillation (AF). However, the optimal strategy of a repeat procedure for PVI non-responders remains unclear.</p></sec><sec><title>Objective</title><p>This study aims to investigate the incidence of PVI non-responders in patients undergoing a repeat procedure, as well as the predictors for the recurrence of repeat ablation.</p></sec><sec><title>Methods</title><p>A total of 276 consecutive patients who underwent repeat ablation from August 2016 to July 2019 in two centers were screened. A total of 64 (22%) patients with durable PVI were enrolled. Techniques such as low voltage zone modification, linear ablation, non-PV trigger ablation, and empirical superior vena cava (SVC) isolation were conducted.</p></sec><sec><title>Results</title><p>After the 20.0 ± 9.9 month follow-up, 42 (65.6%) patients were free from atrial arrhythmias. A significant difference was reported between the recurrent and non-recurrent groups in non-paroxysmal AF (50 vs. 23.8%, <italic>p</italic> = 0.038), diabetes mellitus (27.3 vs. 4.8%, <italic>p</italic> = 0.02), and empirical superior vena cava (SVC) isolation (28.6 vs. 60.5%, <italic>p</italic> = 0.019). Multivariate regression analysis demonstrated that empirical SVC isolation was an independent predictor of freedom from recurrence (95% CI: 1.64–32.8, <italic>p</italic> = 0.009). Kaplan-Meier curve demonstrates significant difference in recurrence between empirical and non-empirical SVC isolation groups (HR: 0.338; 95% CI: 0.131–0.873; <italic>p</italic> = 0.025).</p></sec><sec><title>Conclusion</title><p>About 22% of patients in repeat procedures were PVI non-responders. Non-paroxysmal AF and diabetes mellitus were associated with recurrence post-re-ablation. Empirical SVC isolation could potentially improve the outcome of repeat procedures in PVI non-responders.</p></sec>