Key result
High-density mapping-guided wide antral re-ablation linked to ~61% lower AF recurrence vs conventional re-PVI.
Why the study?
Although repeat PVI is standard for recurrent AF after prior ablation, no consensus exists regarding the most effective redo strategy.
Does wide antral circumferential re-ablation guided by high-density mapping improve arrhythmia-free survival compared to conventional ostial gap ablation in patients with recurrent AF after prior PVI?
Cohort (n=114)
No
Does wide antral circumferential re-ablation guided by high-density mapping improve arrhythmia-free survival compared to conventional ostial gap ablation in patients with recurrent AF after prior PVI?
A wide antral circumferential re-ablation strategy guided by high-density mapping significantly reduces atrial arrhythmia recurrences in redo procedures following pulmonary vein isolation compared to conventional ostial gap ablation.
Answers are grounded in this paper and cite their sources.
May support high-density guided wide antral re-ablation in recurrent AF redo procedures; leaves open confirmation in randomized trials.
Performing repeated pulmonary vein isolation (re-PVI) after recurrent atrial fibrillation (AF) following prior PVI is a standard procedure. However, no consensus exists regarding the most effective approach in redo procedures. We assessed the efficacy of re-PVI using wide antral circumferential re-ablation (WACA) supported by high-density electroanatomical mapping (HDM) as compared to conventional re-PVI. Consecutive patients with AF recurrences showing true PV reconnection (residual intra-PV and PV antral electrical potentials within the initial ablation line) or exclusive PV antral potentials (without intra-PV potentials) in the redo procedure were prospectively enrolled and received HDM-guided WACA (Re-WACA group). Conventional re-PVI patients treated using pure ostial gap ablation guided by a circular mapping catheter served as a historical control (Re-PVI group). Patients with durable PVI and no antral PV potentials were excluded. Arrhythmia recurrences ≥30 s were calculated as recurrences. In total, 114 patients were investigated (Re-WACA: n = 56, 68 ± 10 years, Re-PVI: n = 58, 65 ± 10 years). There were no significant differences in clinical characteristics including the AF type or the number of previous PVIs. In the Re-WACA group, 11% of patients showed electrical potentials only in the antrum but not inside any PV. At 402 ± 71 days of follow-up, the estimated freedom from arrhythmia was 89% in the Re-WACA group and 69% in the Re-PVI group (p = 0.01). Re-WACA independently predicted arrhythmia-free survival (HR = 0.39, 95% CI 0.16–0.93, p = 0.03), whereas two previous PVI procedures predicted recurrences (HR = 2.35, 95% CI 1.20–4.46, p = 0.01). The Re-WACA strategy guided by HDM significantly improved arrhythmia-free survival as compared to conventional ostial re-PVI. Residual PV antral potentials after prior PVI are frequent and can be easily visualized by HDM.
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Hartl et al. (2023) conducted a cohort in Recurrent atrial fibrillation after prior pulmonary vein isolation (n=114). Wide antral circumferential re-ablation (Re-WACA) guided by high-density mapping vs. Conventional re-PVI (ostial gap ablation) guided by a circular mapping catheter was evaluated on Arrhythmia-free survival at mean 402 days (HR 0.39, 95% CI 0.16-0.93, p=0.03). Wide antral circumferential re-ablation guided by high-density mapping significantly improved arrhythmia-free survival (HR 0.39) compared to conventional ostial re-PVI in patients with recurrent atrial fibrillation.
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