Intraprocedural Findings and Outcomes of Redo Procedures After Voltage-Guided Ablation of Persistent Atrial Fibrillation

Background/Objectives: Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. Recently, a randomized study showed that adding voltage-guided ablation (VGA) in persistent AF cases was beneficial. The aim of the present study was to evaluate the safety, efficacy and predictors of success of redo procedures after VGA in an exclusively persistent AF cohort. Methods: Data are derived from the prospective Erfurt AF ablation registry. Starting in 2015, ablation procedures were performed using CARTO3D and VGA. Patients receiving their first redo procedure between 01/2015 and 08/2022 were included. Follow-up included 72 h Holter ECG or device interrogation, ECG, symptom-triggered event recording, and questioning at 3 and 12 months after the redo procedure. The primary endpoint was freedom of recurrence of AF or atrial tachycardia (AT) without drugs between 3 and 12 months. Results: Altogether, 683 patients received a first VGA between January 2015 and May 2022, and 77 patients had their first redo procedure occurring 20 ± 17 months after the first procedure. During the first redo procedure, reconnected PVs were found in 44%, reconnected lines in 23% and new or progressive LVZs in 57% of patients. Complications occurred in two patients (2.6%). During follow-up one patient died, and one did not participate due to aphasia. It was found that 69% were free of recurrence and 61% were free of recurrence off drugs. Patients with recurrence were older than those without recurrence off drugs (73 ± 6 versus 69 ± 9 years, p = 0.049). Conclusions: Redo procedures after VGA in persistent AF have comparatively good results; although, many patients have progressive fibrosis.