Study Cohort
We conducted a single-center, retrospective cohort study comprising patients, derived from an IRB-approved, prospectively populated clinical database of AF ablation patients. All patients underwent first repeat AF or atypical AFL ablation between January 2012 to July 2019 at the Johns Hopkins Hospital. Of the 336 patients who participated in this analysis, 289 had an index PVI with RF energy, while 46 had index cryoballoon ablation. The total patient cohort was divided into two groups (recurrent AF and atypical AFL) based on the recurrent arrhythmia identified during clinical follow-up and prompting repeat ablation. Patients presenting with episodes of both AF and atypical AFL were included in the AF cohort.
The demographics, clinical history, procedural data, complications, and outcomes were recorded for each case. Patients found to have typical AFL only at repeat ablation were excluded from this analysis. Arrhythmia recurrence and peri-procedural complications were ascertained based on monitoring strategies put forth in the 2017 Heart Rhythm Society(1) (HRS) consensus document. Arrhythmia recurrence was defined as any AF or atrial tachyarrhythmia (AT) sustained for >30 s recorded by a surface electrocardiogram or rhythm monitoring device after a 90-day blanking period. Procedure-related complications, such as major bleeding, minor bleeding, phrenic nerve palsy, cerebral embolism, pericardial effusion/tamponade, atrioesophageal fistula, or extended hospitalization, were assessed.