Virtual Conference
Heart 2022 Conference


Central Clinical Hospital , Russian Federation

Title: Recurrence of atrial fibrillation after radiofrequency pulmonary veins isolation: the role of pulmonary vein reconnection


It is well known that pulmonary vein electrical isolation is a first line treatment in all atrial fibrillation radiofrequency ablation procedures. Responsibility of pulmonary veins reconnection for atrial fibrillation recurrent is an unresolved problem

The aim of the study was to investigate the role of pulmonary veins reconnection in recurrence of atrial fibrillation

Method. Fifty-six (65,96 ± 8,86 years old, 33 man) patients with recurrent persistent or high-burden paroxysmal AF, presented typical ECG patterns with spontaneous AF in EP lab during redo EP procedure were included. Totally 224 pulmonary veins were investigated. Pulmonary veins reconnection group included 30, and no reconnection group - 26 patients. High-density mapping was performed by multielectrode mapping, or ablation catheters. We used LASSO catheter for diagnosis of PV reconnection. Entrance and exit PV electrical activity were studied.

Results. In PV reconnection group 46 out of 224 (20,5%) veins in 30 of 56 patients (53,6%) were reconnected. No reconnection group has shown significantly greater CHA2DS2VASc score level. But recurrence rates were similar in PV reconnection and no-reconnection groups for 5 years follow up period. PV activity in PV reconnection group as a trigger of arrhythmia recurrence was found only in 3 out of 46 reconnected veins in 3 out of thirty patents. Pulmonary vein reconnection activities were met significantly rare. The main mechanisms of arrhythmia in PV reconnection group were – foci activity in left and right pulmonary veins, and macroreentry around LIPV (P?2 < 0,001). The effectiveness of sinus rhythm restorations was similar between two group of patients with and without pulmonary vein reconnection.

Conclusion: Pulmonary vein reconnection after pulmonary vein radiofrequency ablation is common, but it is not responsible for atrial fibrillation recurrence in most clinical cases. More often focal activity or macroreentry mechanisms localized on other sites are responsible for atrial fibrillation recurrence.


Department of Surgical Treatment of Complex Cardiac Arrhythmias and Cardiac Pacing. Central Clinical Hospital with Policlinic of the Presidential Administration of the Russian Federation