Repeat ablation
Repeat ablation was more frequent in patients with LVAs (group B+C) than those without (group A, Table 1). Median duration between the initial and second ablation sessions was 10 (8, 16) months.
In the second ablation procedure, proportions of complete PV isolation, defined as isolation of all 4 pulmonary veins from the left atrium, were comparable between the groups, namely 49% (23 of 46) patients in group A, 36% (5 of 14) in group B, 33% (3 of 9) in group C, and 50% (1 of 2, p = 0.73) in group D. All reconnected PVs were successfully isolated.
During the repeat ablation procedure, a total of 31 regular ATs could provide a complete activation map, developed spontaneously or by atrial burst pacing, with higher frequency in patients with LVAs (group B+C) than in those without LVA (group A, Figure 4A). Patients with LVA ablation (group B) experienced regular ATs more frequently than those without (group C). AT circuits determined by electroanatomical mapping are demonstrated in Figure 4B. Ablation successfully eliminated 29 of 31 (93.5%) ATs. The remaining 2 ATs with failed ablation were biatrial tachycardias observed in group B.
Ablation lesions throughout all ablation procedures are shown in Table 1. Patients with LVAs (group B+C) more frequently underwent extra PV ablation than those without (group A). Patients in group B more often received left atrial roof, bottom and anterior-septal linear ablations than those in group C. In contrast, non-PV AF trigger ablation was more frequent in group C than in group B.