Key result
Adjunctive posterior wall isolation shows no benefit over redo PVI alone for arrhythmia-free survival.
Why the study?
Does adjunctive posterior wall isolation (PWI) improve arrhythmia-free survival compared to redo pulmonary vein isolation (PVI) alone in patients undergoing repeat catheter ablation for atrial fibrillation?
Cohort (n=244)
Yes
Does adjunctive posterior wall isolation (PWI) improve arrhythmia-free survival compared to redo pulmonary vein isolation (PVI) alone in patients undergoing repeat catheter ablation for atrial fibrillation?
Absolute Event Rate: 72% vs 69%
p-value: p=0.517
In patients undergoing repeat catheter ablation for atrial fibrillation, adding posterior wall isolation to pulmonary vein isolation prolongs procedure time without significantly improving arrhythmia-free survival.
Adjunctive PWI may not warrant routine use in redo AF ablation; leaves open benefit in randomized trials.
BACKGROUND: Durable pulmonary vein isolation (PVI) is the primary objective of catheter ablation of atrial fibrillation (AF). In repeat procedures, posterior wall isolation (PWI) is the primary adjunctive target, particularly with pulsed-field ablation (PFA), although evidence supporting its clinical benefit remains limited. OBJECTIVE: This study aimed to compare procedural characteristics, safety, and efficacy of 2 ablation strategies in repeat AF ablation: redo PVI alone (PVI group) vs redo PVI with adjunctive PWI (PVI+ group). METHODS: Consecutive patients undergoing redo PVI at 2 centers, with 1-2 reconnected pulmonary veins identified on preablation mapping, were enrolled. PFA or radiofrequency ablation was used in the PVI group, whereas only PFA was used in the PVI+ group. Propensity score matching (1:1 ratio) was performed. RESULTS: A total of 122 patients were included in each group (median age 67 years; 30% female). Median left atrial diameter was 41 mm [37-46], and 46% had persistent AF. Procedure duration, left atrial dwell time, and fluoroscopy time were significantly shorter in the PVI group (all P < .001). Procedural success was 100% in both groups. 1 major complication occurred in each group (0.8%). At a median follow-up of 370 days, arrhythmia-free survival was 69% in the PVI group and 72% in the PVI+ group (P = .517). CONCLUSION: Redo PVI with or without adjunctive PWI is safe and effective, with comparable arrhythmia-free survival. Adjunctive PWI prolongs procedural duration without improving outcomes. Randomized trials are required to clarify its role.
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Badertscher et al. (2026) conducted a cohort in Atrial Fibrillation (n=244). Redo PVI with adjunctive PWI vs. Redo PVI alone was evaluated on Arrhythmia-free survival (p=0.517). Redo pulmonary vein isolation with adjunctive posterior wall isolation resulted in similar arrhythmia-free survival compared to redo pulmonary vein isolation alone (72% vs 69%; P=0.517).
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