Non-Pulmonary Vein Versus Pulmonary Vein Targeting in Ablation for Atrial Fibrillation

According to a study, published in the Journal of Cardiovascular Electrophysiology, approximately 18% of patients with atrial fibrillation (AFib) have to undergo a repeat ablation procedure within 12 months of their first ablation; However, according to the study’s lead author, Daniel Mol and colleagues, there is a lack of studies that have directly compared non-pulmonary vein (PV) and PV targeting in repeat ablations for AFib. The researchers examined modalities of both approaches, and reported that “non-PV target repeat ablation did not improve outcomes after 12 months, and was independently associated with an increased risk for [atrial tachycardia (AT)] recurrences,” compared to PV target ablation.

The multicenter study was conducted on data of 280 retrospective patients who had undergone repeat ablation for AFib, 140 with non-PV target and 140 with PV target ablation. The strategy used for repeat ablation was chosen by the operator. Non-PV target ablations included PV re-isolation, posterior wall isolation, mitral line, roofline, and complex fractionated atrial electrogram ablation, while PV target ablations included re-isolation and wide atrium circumferential ablation.

After 12 months of follow-up, more atrial tachyarrhythmias were seen in the non-PV target group (48.6%) compared to the PV target group (29.3%; p = 0.001). Additionally, the authors reported that “a significantly higher AFib and atrial tachycardia (AT) recurrence rate was observed after non-PV target ablation compared to PV target ablation (36.4% versus 22.1% and 22.9% versus 10.7%).” Furthermore, while both groups had significantly reduced anti-arrhythmic drug use, de-escalation was “more profound” in the PV target group. Lastly, patients with isolated PVs during non-PV target ablation had a significantly higher risk for AFib recurrence than those with reconnected PVs.

Ultimately, after the significantly higher risk of AT recurrence in non-PV target ablation was confirmed via adjusted analysis, the authors concluded that non-PV target ablation for AFib techniques were not superior to PV target ablation after 12 months, and even appeared to introduce higher risk of recurrence.