HDM-guided wide antral circumferential re-ablation significantly improved estimated freedom from arrhythmia compared to conventional ostial re-PVI (89% vs 69%; HR 0.39, 95% CI 0.16-0.93, p=0.03).
Cohort (n=114)
Does HDM-guided wide antral circumferential re-ablation improve freedom from arrhythmia compared to conventional ostial re-PVI in patients with recurrent AF after prior PVI?
High-density mapping-guided wide antral circumferential re-ablation significantly improves arrhythmia-free survival compared to conventional ostial re-PVI in patients with recurrent atrial fibrillation.
Hazard Ratio: 0.39 (95% CI 0.16–0.93)
Tasa de eventos absoluta: 89% vs 69%
valor p: p=0.03
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.
Hartl et al. (Fri,) conducted a cohort in Recurrent atrial fibrillation after prior pulmonary vein isolation (n=114). Wide antral circumferential re-ablation (WACA) supported by high-density electroanatomical mapping (HDM) vs. Conventional re-PVI using pure ostial gap ablation guided by a circular mapping catheter (historical control) was evaluated on Freedom from arrhythmia (arrhythmia recurrences ≥30 s) (HR 0.39, 95% CI 0.16-0.93, p=0.03). HDM-guided wide antral circumferential re-ablation significantly improved estimated freedom from arrhythmia compared to conventional ostial re-PVI (89% vs 69%; HR 0.39, 95% CI 0.16-0.93, p=0.03).
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