Characteristics of symptomatic recurrent tachyarrhythmia after thoracoscopic ablation for persistent atrial fibrillation

Background: Recurrent atrial tachyarrhythmia (ATa) is a challenge in all ablation procedures for atrial fibrillation (AF). However, data on ATa after totally thoracoscopic ablation (TTA) is lacking. This study aimed to investigate the mechanisms and outcomes of recurrent ATa after TTA. Methods: Eligible patients for the present study were those who underwent electrophysiologic study and catheter-based radiofrequency ablation (RFA) at least 3 months after TTA for symptomatic recurrent ATa that was refractory to antiarrhythmic drugs and/or cardioversion. Follow-up outcomes included recurrent ATa after first or repeated RFA. Results: A consecutive 154 TTA patients were evaluated. A total of 24 patients showed symptomatic recurrent ATa after TTA, and 22 underwent RFA. Half of the patients (11/22, 50%) had AF as a form of recurrent ATa. Nonpulmonary vein (PV)-related mechanisms of ATa were noted in half of patients. PV gaps showed a characteristic distribution: most gaps in right PVs were located at the posterior ridge (71.4%) with the posterior ridge of left PVs saved in all patients. Post-RFA recurrence rate was 27.3% during a median follow-up of 9.1 months, with all recurrences except for one occurring within 3 months after first RFA. Conclusions: During a median of 17.8 months after TTA, 24 patients (24/154, 15.6%) developed symptomatic recurrent ATa, and 22 patients underwent RFA. Post-RFA recurrence rate was 27.3%, which mostly occurred within 3 months after RFA. Catheter-based ablation of recurrent arrhythmias may be effective, but challenging.