Predictors and Characteristics of Multiple (More Than 2) Catheter Ablation Procedures for Atrial Fibrillation

Li Wei Lo, Yenn Jiang Lin, Shih Lin Chang, Yu Feng Hu, Tze Fan Chao, Fa Po Chung, Jo Nan Liao, Cheun Wang Chiou, Hsuan Ming Tsao, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Characteristics of Multiple AF Ablation Procedures Background The recurrence of atrial fibrillation (AF) is not uncommon in the era of catheter ablation. This study aimed to evaluate the characteristics of AF patients who underwent multiple (>2) ablation procedures. Methods and Results Of 666 consecutive patients (53 ± 11 y/o, 484 men) who underwent catheter ablation of AF (paroxysmal AF, n = 530), 144 (22%) underwent 2 procedures and 52 (8%) underwent more than 2 procedures due to symptomatic recurrences refractory to medication during 48 ± 23 months of follow-up. Baseline and procedural characteristics at the index procedure were investigated to determine their impact on the necessity of multiple procedures. After 2 procedures, 48 (92%) of 52 patients had pulmonary vein (PV) ectopic beats initiating AF. Coexisting PV and non-PV triggers were found in 23 of 48 patients. In a multivariate analysis, the presence of non-PV triggers (P = 0.004; odds ratio 2.69, 95% CI 1.37-5.28) at the index procedure was the only independent predictor of necessary multiple procedures. Among patients with non-PV ectopic beats initiating AF at the index procedure, the presence of ligament of Marshall triggers (P = 0.001, odds ratio 6.74, 95% CI 2.13-21.32) could predict the necessity of multiple procedures. Conclusions The need for multiple catheter ablation procedures can be predicted by the presence of non-PV ectopic beats initiating AF at the index procedure. However, PV-initiated AF remains the major cause of AF recurrence despite multiple catheter ablation procedures.

Original languageEnglish
Pages (from-to)1048-1056
Number of pages9
JournalJournal of cardiovascular electrophysiology
Issue number10
StatePublished - Oct 2015


  • atrial fibrillation
  • catheter ablation
  • nonpulmonary vein ectopy
  • pulmonary vein isolation
  • recurrence


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