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April 4, 2026Heart Rhythm O20 citationsOpen Access

Rotor-Guided Tailor-Made Pulmonary Vein Isolation for Persistent Atrial Fibrillation: Identification of the Left Atrial Septum as a Common Arrhythmogenic Substrate

YSYuya SuzukiKTKaoru TakamiDSDaisuke Shiraishi

Key Result

Rotor-guided extended pulmonary vein isolation significantly improved 12-month freedom from atrial fibrillation recurrence compared to PVI alone or PVI plus PWI (p=0.004).

Key Points

  • The aim is to identify effective approaches for treating persistent atrial fibrillation, focusing on left atrial structures.
  • Utilized rotor-guided techniques for pulmonary vein isolation (PVI)
  • Compared outcomes between rotor-guided extended PVI and traditional PVI methods
  • Employed log rank test for statistical analysis of arrhythmia recurrence
  • Freedom from atrial fibrillation or atrial tachycardia improved in rotor-guided extended PVI group
  • Significant p-value of 0.004 indicating strong evidence against no difference between groups

Structured PICO

Does rotor-guided extended PVI reduce AF/AT recurrence in patients with persistent atrial fibrillation?

P
Population
Patients with persistent atrial fibrillation (PerAF) undergoing initial catheter ablation
I
Intervention
Rotor-guided extended PVI (cryoballoon PVI followed by radiofrequency line extension to encompass adjacent AF rotors identified by ExTRa Mapping)
C
Comparator
Cryoballoon PVI alone or radiofrequency-based PVI plus posterior wall isolation (PWI)
O
Outcome
Freedom from AF/AT recurrence without antiarrhythmic drugs at 12 months

A tailored ablation strategy combining cryoballoon PVI with ExTRa Mapping-guided radiofrequency ablation of adjacent rotors significantly reduces AF/AT recurrence in patients with persistent atrial fibrillation without increasing iatrogenic atrial tachycardia.

Abstract

Log rank test, p = 0.004 Follow-up (months) Freedom from AF/AT recurrence 0 2 4 6 8 10 12 1.0 0.8 0.6 0.4 0.2 0 Number at risk Rotor-guided extended PVI group PVI-alone group PVI plus PWI group Rotor-guided extended PVI group PVI-alone group PVI plus PWI group

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Cite This Study

Suzuki et al. (2026) studied this question. Rotor-guided extended pulmonary vein isolation significantly improved 12-month freedom from atrial fibrillation recurrence compared to PVI alone or PVI plus PWI (p=0.004).

synapsesocial.com/papers/69d0adc2659487ece0fa4534https://doi.org/10.1016/j.hroo.2026.03.029
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1102 Arrhythmia recurrence following durable pulmonary vein isolation and posterior wall isolation in persistent atrial fibrillation: a randomised study2024
  2. 2Visually guided pulmonary vein isolation in patients with persistent atrial fibrillation2015 · 16 citations
  3. 3Effect of pulmonary vein isolation on rotor/multiple wavelet dynamics in persistent atrial fibrillation, association with vagal response and implications for adjunctive ablation2022 · 7 citations
  4. 4Left Pulmonary Veins Isolation: The Cornerstone in Noninvasive Evaluation of Substrate Modification After Catheter Ablation of Paroxysmal Atrial Fibrillation2022 · 1 citations
  5. 5Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation2020 · 11 citations