Undergoing 3 or More Catheter Ablation Procedures for AF
The main purpose of the study was to report the electrophysiological findings at the time of the repeat ablation procedure in patients requiring ≥3 procedures. Long-term freedom from recurrent atrial tachyarrhythmias (AF or organized atrial tachyarrhythmia [OAT]) was also assessed. Long-term follow-up consisted of at least 3 outpatient visits (at 6 weeks, 6 months, and 1 year from the date of ablation). Patients were provided with a 30-day transtelephonic monitor at discharge from the hospital and at 6 months. Additional transtelephonic monitoring was performed if patients reported arrhythmia symptoms in between visits. Beyond 1 year, patients were encouraged to return for outpatient evaluation semiannually. At each outpatient visit, patients were queried for symptoms and a 12-lead ECG was obtained. Patients were also instructed to assess their pulse twice daily and report any irregularity of pulse or recurrence of symptoms immediately, at which point additional event monitoring was performed. Arrhythmia recurrence was assumed based on recurrence of any symptoms and or asymptomatic ECG showing atrial fibrillation/flutter lasting >30 seconds. We reported outcomes in patients with >12 month follow-up from the last procedure.
Patients were routinely continued on an antiarrhythmic drug (AAD) for 1–6 months postablation. In the absence of structural heart disease, a class IC drug was typically used. Patients who were on amiodarone preablation were changed to a different AAD postablation unless other AADs were not tolerated or otherwise contraindicated. Discontinuation of AADs was encouraged after 6–12 weeks in patients with paroxysmal AF preablation and after 6 months in patients with persistent AF preablation. Decisions to discontinue AAD were done in consultation with referring physician and with input from the patient. Continued antiarrhythmic drug therapy was documented.
The first 90 days after ablation were censored from follow-up for judging procedure efficacy. Procedural success was defined as AF control based on patient status ≥1 year after the last ablation procedure (≥300 days after the blanking period) and categorized as: (1) no AF episodes off antiarrhythmic therapy; (2) no AF episodes on any antiarrhythmic drug; or (3) rare AF. The latter category was included to highlight good long-term clinical outcome in a small group of patients who experience a rare episode of AF. We defined this rare AF as ≤6 AF episodes (median 2 episodes) over the follow-up year that terminated either spontaneously and/or with a single cardioversion and/or a >95% reduction in AF burden when monitoring was compared pre- and postablation (mainly used in patients with implantable devices).
Study Endpoints and Follow-up
The main purpose of the study was to report the electrophysiological findings at the time of the repeat ablation procedure in patients requiring ≥3 procedures. Long-term freedom from recurrent atrial tachyarrhythmias (AF or organized atrial tachyarrhythmia [OAT]) was also assessed. Long-term follow-up consisted of at least 3 outpatient visits (at 6 weeks, 6 months, and 1 year from the date of ablation). Patients were provided with a 30-day transtelephonic monitor at discharge from the hospital and at 6 months. Additional transtelephonic monitoring was performed if patients reported arrhythmia symptoms in between visits. Beyond 1 year, patients were encouraged to return for outpatient evaluation semiannually. At each outpatient visit, patients were queried for symptoms and a 12-lead ECG was obtained. Patients were also instructed to assess their pulse twice daily and report any irregularity of pulse or recurrence of symptoms immediately, at which point additional event monitoring was performed. Arrhythmia recurrence was assumed based on recurrence of any symptoms and or asymptomatic ECG showing atrial fibrillation/flutter lasting >30 seconds. We reported outcomes in patients with >12 month follow-up from the last procedure.
Use of Antiarrhythmic Drugs
Patients were routinely continued on an antiarrhythmic drug (AAD) for 1–6 months postablation. In the absence of structural heart disease, a class IC drug was typically used. Patients who were on amiodarone preablation were changed to a different AAD postablation unless other AADs were not tolerated or otherwise contraindicated. Discontinuation of AADs was encouraged after 6–12 weeks in patients with paroxysmal AF preablation and after 6 months in patients with persistent AF preablation. Decisions to discontinue AAD were done in consultation with referring physician and with input from the patient. Continued antiarrhythmic drug therapy was documented.
Procedure Outcome
The first 90 days after ablation were censored from follow-up for judging procedure efficacy. Procedural success was defined as AF control based on patient status ≥1 year after the last ablation procedure (≥300 days after the blanking period) and categorized as: (1) no AF episodes off antiarrhythmic therapy; (2) no AF episodes on any antiarrhythmic drug; or (3) rare AF. The latter category was included to highlight good long-term clinical outcome in a small group of patients who experience a rare episode of AF. We defined this rare AF as ≤6 AF episodes (median 2 episodes) over the follow-up year that terminated either spontaneously and/or with a single cardioversion and/or a >95% reduction in AF burden when monitoring was compared pre- and postablation (mainly used in patients with implantable devices).
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