Study design and patient population
The present study is an observational, retrospective, multicenter,
real-world cohort study performed at 8 centers in the Netherlands. We
identified all repeat ablations performed in these centers between
2016-2019 through the Netherlands Heart Registration (NHR). The NHR is a
nationwide, non-voluntary, quality monitoring registry in the
Netherlands dedicated to collecting comprehensive data on cardiovascular
diseases and interventions, including all AF ablations performed in the
Netherlands since 2013.(14) With regards to ablation procedures, the
collected data include demographic characteristics, including medical
history, and procedural data related to the ablation procedures
(detailed overview of the variables included in the NHR ablation
registry (15)). The study was approved by the institutional review board
MEC-U (W19.270) and conducted in accordance with the principles of the
Declaration of Helsinki. A waiver of informed consent was obtained for
the analysis of data from the NHR data registry.
The inclusion criteria for the study were the following: (1) a history
of paroxysmal or persistent AF (defined respectively as AF that
terminates spontaneously or with intervention within 7 days of onset and
AF that is sustained for more than 7 days, or less than 7 days but
requires pharmacological or electrical cardioversion to terminate)
treated with ablation procedure(s) consisting solely of PVI; (2)
documented AF recurrence (12 lead ECG, Holter, ECG rhythm strips) after
the 1st ablation procedure; (3) first repeat ablation
performed between 2016 and 2019 during which all PVs were durably
isolated on electrophysiological mapping.
Patients were excluded if they underwent surgical ablation during prior
procedures or other lesions were performed during the prior ablations
(except for cavo-tricuspid isthmus ablation), or if the indication of
the repeat procedure was for atrial tachycardia (AT) or atrial flutter
(AFL).