When Should We Decide to Perform a Repeat Pulmonary Vein Isolation Procedure in Patients with Atrial Fibrillation?

Background: It is sometimes difficult to differentiate the transient appearance of atrial fibrillation (AF) after pulmonary vein (PV) isolation from a true recurrence of AF. We attempted to differentiate them by analyzing the time course after the procedure.Methods and Results: 79 patients who underwent PV isolation were divided into two groups (successful: N = 60 and unsuccessful: N = 19) according to the final outcome. Antiarrhythmic drugs were used either temporarily or continuously to treat re-appearance of AF after the procedure. The transient appearance of AF in the successful group gradually faded, while true AF recurrence in the unsuccessful group consistently increased in line with the follow-up (F/U) period. The appearance of AF after 3 months predicted a subsequent failure of the procedure with a positive/negative predictive value of 87/90%, respectively.Conclusion: Since the transient appearance of AF decreased and the true recurrence of AF increased in line with the F/U period, we should therefore wait at least 3 months before judging the outcome of PV isolation.