Table_1_Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China.XLSX

BackgroundPulmonary vein isolation (PVI) is the standard ablation strategy for treating atrial fibrillation (AF). However, the optimal strategy of a repeat procedure for PVI non-responders remains unclear.ObjectiveThis study aims to investigate the incidence of PVI non-responders in patients undergoing a repeat procedure, as well as the predictors for the recurrence of repeat ablation.MethodsA total of 276 consecutive patients who underwent repeat ablation from August 2016 to July 2019 in two centers were screened. A total of 64 (22%) patients with durable PVI were enrolled. Techniques such as low voltage zone modification, linear ablation, non-PV trigger ablation, and empirical superior vena cava (SVC) isolation were conducted.ResultsAfter the 20.0 ± 9.9 month follow-up, 42 (65.6%) patients were free from atrial arrhythmias. A significant difference was reported between the recurrent and non-recurrent groups in non-paroxysmal AF (50 vs. 23.8%, p = 0.038), diabetes mellitus (27.3 vs. 4.8%, p = 0.02), and empirical superior vena cava (SVC) isolation (28.6 vs. 60.5%, p = 0.019). Multivariate regression analysis demonstrated that empirical SVC isolation was an independent predictor of freedom from recurrence (95% CI: 1.64–32.8, p = 0.009). Kaplan-Meier curve demonstrates significant difference in recurrence between empirical and non-empirical SVC isolation groups (HR: 0.338; 95% CI: 0.131–0.873; p = 0.025).ConclusionAbout 22% of patients in repeat procedures were PVI non-responders. Non-paroxysmal AF and diabetes mellitus were associated with recurrence post-re-ablation. Empirical SVC isolation could potentially improve the outcome of repeat procedures in PVI non-responders.

背景：肺静脉隔离术（PVI）是治疗心房颤动（AF）的标准消融策略。然而，针对PVI非应答者的重复手术最佳策略尚不明确。目的：本研究旨在探讨接受重复手术的患者中PVI非应答者的发生率，以及重复消融复发的预测因素。方法：对2016年8月至2019年7月在两个中心接受重复消融的276名连续患者进行了筛选。共有64名（22%）患者被纳入研究，其PVI效果持久。采用了诸如低电压区修改、线性消融、非肺静脉触发消融以及经验性上腔静脉（SVC）隔离等技术。结果：在平均20.0±9.9个月的随访后，42名（65.6%）患者免于心房心律失常。在复发性与未复发性组之间，非阵发性心房颤动（50% vs. 23.8%，p = 0.038）、糖尿病（27.3% vs. 4.8%，p = 0.02）以及经验性SVC隔离（28.6% vs. 60.5%，p = 0.019）方面存在显著差异。多变量回归分析显示，经验性SVC隔离是复发自由独立的预测因素（95% CI：1.64–32.8，p = 0.009）。Kaplan-Meier曲线显示，经验性SVC隔离组与非经验性SVC隔离组在复发率上存在显著差异（HR：0.338；95% CI：0.131–0.873；p = 0.025）。结论：约22%的重复手术患者为PVI非应答者。非阵发性心房颤动和糖尿病与重复消融后的复发相关。经验性SVC隔离可能有助于改善PVI非应答者重复手术的预后。