Predictors and Characteristics of Multiple (More Than 2) Catheter Ablation Procedures for Atrial Fibrillation.

Background: The recurrence of atrial fibrillation (AF) is not uncommon in the era of catheter ablation. This study aimed to evaluate the characteristics of AF patients who underwent multiple (>2) ablation procedures.

Results: Of 666 consecutive patients (53 ± 11 y/o, 484 men) who underwent catheter ablation of AF (paroxysmal AF, n = 530), 144 (22%) underwent 2 procedures and 52 (8%) underwent more than 2 procedures due to symptomatic recurrences refractory to medication during 48 ± 23 months of follow-up. Baseline and procedural characteristics at the index procedure were investigated to determine their impact on the necessity of multiple procedures. After 2 procedures, 48 (92%) of 52 patients had pulmonary vein (PV) ectopic beats initiating AF. Coexisting PV and non-PV triggers were found in 23 of 48 patients. In a multivariate analysis, the presence of non-PV triggers (P = 0.004; odds ratio 2.69, 95% CI 1.37-5.28) at the index procedure was the only independent predictor of necessary multiple procedures. Among patients with non-PV ectopic beats initiating AF at the index procedure, the presence of ligament of Marshall triggers (P = 0.001, odds ratio 6.74, 95% CI 2.13-21.32) could predict the necessity of multiple procedures.

Conclusions: The need for multiple catheter ablation procedures can be predicted by the presence of non-PV ectopic beats initiating AF at the index procedure. However, PV-initiated AF remains the major cause of AF recurrence despite multiple catheter ablation procedures.