Why the study?
Although catheter ablation targeting spatiotemporal dispersion electrograms (STDEs) in addition to PVI reduces persistent AF recurrence, comprehensive reports on changes in STDE area before and after PVI were lacking.
Does ablation targeting spatiotemporal dispersion electrograms mapped after pulmonary vein isolation reduce atrial fibrillation recurrence in patients with persistent atrial fibrillation compared to mapping before PVI?
Cohort (n=83)
Does ablation targeting spatiotemporal dispersion electrograms mapped after pulmonary vein isolation reduce atrial fibrillation recurrence in patients with persistent atrial fibrillation compared to mapping before PVI?
Mapping and targeting spatiotemporal dispersion electrograms after pulmonary vein isolation significantly reduces the ablation target area without compromising 1-year freedom from atrial fibrillation.
Post-PVI STDE reduction was not associated with lower AF recurrence; leaves open whether targeting residual STDEs adds benefit in persistent AF.
Background Recently, the TAILORED AF trial reported that catheter ablation targeting spatiotemporal dispersion electrograms (STDEs), in addition to pulmonary vein isolation (PVI), was associated with a decreased risk of atrial fibrillation (AF) recurrence after the ablation compared to the conventional approach in patients with persistent AF. We often experienced that the area of STDE decreased after PVI; however, there has been no comprehensive report. Purpose We investigated the changes in the STDE area obtained before and after PVI, as well as the outcomes of ablation targeting the STDEs mapped after PVI. Methods We retrospectively enrolled 30 consecutive patients (median 66 [60–71] years old, 27 men) with persistent AF who underwent STDE map before and after PVI. STDE was defined as clusters of fractionated or non-fractionated electrograms with time and space dispersion. The surface area of STDEs was calculated using the Ensite system. If STDEs were found on the LA posterior wall, BOX isolation was performed. STDEs on the other sites were ablated focally. We compared the AF recurrence after ablation in these 30 patients who underwent PVI plus STDEs ablation mapped after PVI with a historical cohort (n=53) undergoing both PVI and STDEs ablation obtained before PVI. Results The median duration of AF was 9 (4–22) months, and the left atrial diameter measured by echocardiography and left atrial volume measured by computed tomography were 42 (40–45) mm and 143 (116–176) mL, respectively. PVI was successfully performed in all the patients. The STDE area mapped after PVI was significantly smaller than before (27±18 cm2 to 8.3±8.1 cm2; P<0.001). The Kaplan-Meier curve showed no significant difference in the AF recurrence rate at 1 year after the ablation between targeting STDEs mapped before and after PVI (P=0.497). Conclusions The STDE areas decreased significantly after PVI. Ablation targeting STDEs mapped after PVI did not increase the AF recurrence after the ablation, compared with those mapped before PVI.
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Naruse et al. (2026) conducted a cohort in Persistent atrial fibrillation (n=83). Ablation targeting STDEs mapped after PVI vs. Ablation targeting STDEs mapped before PVI (historical cohort) was evaluated on Atrial fibrillation recurrence rate at 1 year after the ablation (p=0.497).
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