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Journal Articles Circulation. Arrhythmia and electrophysiology Year : 2023

Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study

Antoine Milhem
  • Function : Author
Séverine Philibert
Serge Boveda
Clément Bars
  • Function : Author
Frédéric Anselme
Baptiste Maille
  • Function : Author
Clémentine André
  • Function : Author
Albin Behaghel
  • Function : Author
Ghassan Moubarak
  • Function : Author
Nicolas Clémenty
Antoine da Costa
  • Function : Author
Marine Arnaud
Sandrine Venier
  • Function : Author
Frédéric Sebag
  • Function : Author
Laurence Jésel-Morel
  • Function : Author
Audrey Sagnard
Laure Champ-Rigot
Duc Dang
Benoit Guy-Moyat
  • Function : Author
Selim Abbey
Rodrigue Garcia
Olivier Césari
  • Function : Author
Nicolas Badenco
Antoine Lepillier
Sandro Ninni
Stéphane Boulé
  • Function : Author
Philippe Maury
Vincent Algalarrondo
  • Function : Author
Babé Bakouboula
Jacques Mansourati
  • Function : Author
François Lesaffre
Philippe Lagrange
  • Function : Author
Abdeslam Bouzeman
Lucian Muresan
Raoul Bacquelin
Agustin Bortone
Sok-Sithikun Bun
  • Function : Author
Laurent Macle


BACKGROUND: Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS: Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS: Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13–2.23]; P =0.006). CONCLUSIONS: In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.
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Dates and versions

hal-04021122 , version 1 (09-03-2023)



Karim Benali, Valentin Barré, Alexis Hermida, Vincent Galand, Antoine Milhem, et al.. Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study. Circulation. Arrhythmia and electrophysiology, 2023, pp.e011354. ⟨10.1161/CIRCEP.122.011354⟩. ⟨hal-04021122⟩
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