Ablation Procedure and Acute Outcomes
Among the 102 patients in the recurrent atypical AFL cohort, acute
ablative success was achieved in 74 (73.3%) (Table 3). Five (5%)
patients had rhythm conversion to AF during flutter ablation, and 5
(5%) patients had spontaneous termination of atypical AFL. A total of 9
(8.9%) patients required cardioversion to achieve NSR. Acute procedural
success was achieved in 100% of patients in the recurrent AF cohort
(Table 4). Of the 234 patients undergoing repeat ablation for recurrent
AF, PV reconnection was seen in 196 (83.7%). Four, 3, 2, and 1
reconnected PVs were seen in 42.3%, 12%, 21.7%, and 7.7% of
recurrent AF patients, respectively. In the 102 AFL patients, recurrent
connection of one or more PVs was seen in 76.4%. The mean number of PVs
showing electrical reconnection was significantly higher among patients
in the recurrent AF cohort (2.8 vs. 2.3, p <0.01) than the
recurrent atypical AFL cohort. Similarly, the proportions of all the PVs
with electrical reconnection were also higher in the AF cohort.
As anticipated, a greater proportion of patients in the recurrent
atypical AFL cohort required PVI plus additional ablation (70.2 vs. 50.4
%, p=0.00) and additional ablation strategies (12.7 vs. 0.4 %,
p<0.01) compared to the recurrent AF cohort. The use of mitral
isthmus line ablation (13.4 vs. 0.4% %, p<0.01), roof
ablation (47.1 vs. 26.5, p<0.01) and combination of different
non-PV ablations (46.1 vs. 19.7 %, p=0.00) were significantly higher
among patients in the recurrent AFL cohort.
There were three (0.9%) patients with major complications in the total
cohort undergoing redo ablation, and the incidence of complications
remained comparable between the recurrent AF and AFL cohort. One patient
suffered transient right phrenic nerve paralysis that resolved after two
months, and two patients developed access site pseudoaneurysms treated
successfully with thrombin injections. There were no instances of
cardiac tamponade or perforation, PV stenosis, stroke/TIA,
atrio-esophageal fistula, or procedure-related deaths.