Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations

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In 1998, Haissaguerre et al., for the first time, demonstrated that triggers originating from the pulmonary veins (PV) initiate atrial fibrillation (AF).1 Since then, PV isolation (PVI) has been the mainstay of catheter‐based treatment of AF. However, achieving durable PVI is challenging for several reasons such as incomplete isolation or suboptimal control of postprocedural inflammation. As a result, reconnection of the pulmonary veins is a major limitation of this procedure.2
With the current technologies, up to 60% of patients remain in sinus rhythm one year after a single PVI procedure.3 But, not all recurrences correlate to PV reconnection.2 Recent data suggest the incidence of PV reconnection to be similar between patients with and without AF recurrence.4 Moreover, in many cases, relapse of AF is seen in the presence of permanent PVI, which reflects dynamic alterations in the underlying substrates that lead to the origin of AF‐triggering beats from non‐PV foci.3
It often requires multiple ablation procedures to achieve long‐term sinus rhythm in AF patients. Studies have separately shown the critical role of either PV reconnection or presence of non‐PV triggers or both, in maintaining AF and thus predicting the need for repeat AF ablations.1 However, there is no clarity and consensus regarding the predictors in AF patients that require multiple ablations. Therefore, this study aimed to evaluate procedural characteristics and ablation outcome in AF patients referred to our centers for catheter ablation after two or more failed procedures.
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