Po-02-032 impact of atrial fibrillation triggers on long-term outcomes of a second catheter ablation of non-paroxysmal atrial fibrillation

Catheter ablation (CA) for atrial fibrillation (AF) triggers including non-pulmonary vein (PV) foci contribute to improvement of CA outcome. However, we often experience AF recurrences after an AF trigger ablation in patients with non-paroxysmal AF (PaAF). A second CA session is performed in some cases after a failed first CA, but clinical significance of AF triggers ablation during second procedure in non-PaAF patients is still unknown. We retrospectively analyzed non-PaAF patients receiving a second CA session for eliminating AF triggers and clarified the clinical significance of an AF trigger ablation for the outcomes of the second CA session. 94 patients with non-paroxysmal AF [mean age 63.7 (56.0-72.0) years, 72.2% male] undergoing second CA were enrolled. Intracardiac cardioversion during AF using a high-dose isoproterenol was performed at the beginning of the procedure to determine the presence or absence of AF triggers. We performed re-PV isolation if PV potential recurred, and if AF triggers were appeared from any non-PV sites, we added an additional ablation to that site. In patients without AF triggers, linear ablation, such as left atrium (LA) roof line and/or LA bottom line, superior vena cava isolation, or both were added. Multivariate analyses were carried out to estimate clinical factors associated with late recurrence of AF (LRAF) which means AF recurrence later than 3 months after CA. Of the enrolled 94 patients, AF triggers were identified in 59 patients (70.2%). Of those with AF triggers, 42 patients (71.2%) archived successful elimination of AF triggers, but we could not eliminate all AF triggers in 17 patients (28.8%). During a mean follow-up period of 32.2 (range, 6.25-48.8) months, a total of 55 patients (58.5%) experienced LRAF. Among the patients with AF triggers, 33 (50.8%) experienced LRAF. On the other hand, among those without AF triggers, 22 (75.9%) developed LRAF. Multivariate analysis revealed that the absence of AF triggers was a significant predictor of LRAF [hazard ratio (HR); 2.02, confidence interval (CI); 1.13-3.62, p=0.018]. In sub-analysis in patients with AF triggers, multivariate analysis showed that an unsuccessful elimination of AF triggers was significantly associated with LRAF (HR; 5.06, CI; 2.40-10.68, p<0.001). The absence of AF triggers during the second CA session significantly increased the risk of an LRAF. When AF triggers were present, an unsuccessful AF trigger ablation resulted in poor outcomes.