Optimal observation time after completion of circumferential pulmonary vein isolation for atrial fibrillation to prevent chronic pulmonary vein reconnections

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…265,448,450,451,457,459,460,461 In a retrospective study including patients undergoing a repeat ablation procedure for recurrent AF, receiver operating characteristic analysis revealed a strong negative correlation between the observation time after complete PVI during the initial procedure and chronic PV reconnection. 452 The optimal cutoff value was 35 minutes, although the diagnostic accuracy was not high (sensitivity 66.9%, specificity 60.6%). A small, prospective randomized trial comparing the outcomes of AF ablation in which no waiting period, a 30-minute, and a 60-minute waiting period was incorporated into the ablation procedure revealed a clear benefit of incorporating a 30-minute or longer waiting phase (60.7%, 84.3%, and 86.7%, respectively).…”

“…Despite the importance of this ablation endpoint, permanent electrical isolation of the PVs can rarely be achieved. 263,446,447,448,449,450,451,452,453,454,455,456 Among patients returning to the electrophysiology laboratory for a repeat ablation procedure after failing an initial ablation procedure, most studies report that recurrence of PV conduction is observed in one or more PVs in more than 80% of patients. 263,446,447,452,454 …”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

“… I B-R 245,261,262,456,462,489,503,515,527,655,673, 684,709,733,1015,1025,1026,1027,1030 Monitoring for PV reconnection for 20 minutes following initial PV isolation is reasonable. IIa B-R 263 , 265 , 448 , 450 , 451 , 452 , 457–461 , 462 Administration of adenosine 20 minutes following initial PV isolation using RF energy with reablation if PV reconnection might be considered. IIb B-R 265 , 448 , 449–451 , 454 , 456 , 461 , 463–468 Use of a pace-capture (pacing along the ablation line) ablation strategy may be considered.…”

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary

“… I B-R 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 109 Monitoring for PV reconnection for 20 minutes following initial PV isolation is reasonable. IIa B-R 9 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 Administration of adenosine 20 minutes following initial PV isolation using RF energy with reablation if PV reconnection might be considered. IIb B-R 109 , 111 , 112 , 113 , 114 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 Use of a pace-capture (pacing along the ablation line) ablation strategy may be considered.…”