Acute and long-term outcome of redo catheter ablation for recurrent atrial tachycardia and recurrent atrial fibrillation

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Acute and long-term outcome of redo catheter ablation for recurrent atrial tachycardia and recurrent atrial fibrillation in patients with prior atrial fibrillation ablation Young Choi 1 & Sunhwa Kim 1 & Ju Yeol Baek 1 & Sung-Hwan Kim 1 & Ju Youn Kim 2 & Tae-Seok Kim 3 & Youmi Hwang 4 & Ji-Hoon Kim 4 & Sung-Won Jang 5 & Man Young Lee 6 & Yong-Seog Oh 1 Received: 17 February 2020 / Accepted: 2 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Purpose Organized atrial tachycardia (AT) accounts for a substantial proportion of recurrence after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). We sought to analyze the characteristics and long-term outcome of redo RFCA for recurrent AT compared with those for recurrent AF. Methods We analyzed 133 patients who underwent prior AF ablation and presented for redo RFCA procedure. Documented rhythm at recurrence was AT in 50 patients (37.6%) and AF in 83 patients (62.4%). Redo ablation was conducted using a stepwise approach in all subjects. Results Recurrent arrhythmia was more frequently a persistent type in the AT group (70.0% vs. 36.1% in the AT and AF group, respectively, p < 0.001). Fifty mappable ATs were identified in the AT group. Perimitral reentry was most common (19/50), followed by PV-related focal or reentrant tachycardia (16/50). During the redo RFCA, PV reconnection rate and linear ablation rate were similar in the two groups, while the focal target ablation tended to be conducted more frequently in the AF group (26.0% vs. 42.2%, p = 0.060). The AT group showed a higher acute success rate (92.0% vs. 75.9%, p = 0.019) and higher arrhythmia freedom during a mean of 30 months (76.0% vs. 55.4%, p = 0.030), compared with the AF group. The AT group and de novo AF type (paroxysmal) were independent predictors for higher arrhythmia freedom. Conclusions RFCA for recurrent AT following AF ablation showed favorable acute and long-term success rates and was associated with superior procedural outcomes compared with those for recurrent AF. Keywords Atrial fibrillation . Radiofrequency catheter ablation . Atrial tachycardia . Atrial flutter

1 Introduction Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is a widely adopted procedure in symptomatic drugrefractory patients. However, the risk of arrhythmia recurrence * Yong-Seog Oh [email protected] 1

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Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea

after RFCA is substantial [1–3]. Recurred patients often present with organized atrial tachycardia (AT) which can be caused b