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.