Targetable atrial tachycardias after artificial intelligence–guided ablation of persistent atrial fibrillation

BACKGROUND: The TAILORED-AF randomized trial demonstrated that artificial intelligence-guided ablation of spatiotemporal dispersion in addition to pulmonary vein isolation significantly reduced atrial fibrillation (AF) recurrence at 1-year follow-up in patients with persistent AF. Still, approximately one-third of the population experienced atrial tachycardia (AT) recurrences, most of which were successfully ablated. OBJECTIVE: In this post hoc analysis of the TAILORED-AF trial, we determined the exact mechanism and locations of ATs and examined the adherence to protocol-recommended ablation and its relation to the occurrence of ATs. METHODS: During index procedures, post-AF ATs were diagnosed based on common mapping and pacing maneuvers. Maps pertaining to activation and ablation lesions were evaluated by a panel of experts to assess compliance and completion of the TAILORED-AF protocol recommendations. RESULTS: During the index procedure, 140 ATs (96 patients) were characterized including 76 macroreentrant ATs (29% perimitral, 42% peritricuspid, 20% roof dependent, 9% other), 37 localized ATs, 12 ATs with undetermined mechanisms, and 15 unstable ATs. The percentage of repeat ablations was significantly lower in patients who had a complete ablation set in common macroreentry AT regions (roof, mitral) ablation than patients with an incomplete ablation set (22% vs 48%; P = .02; odds ratio 0.31; 95% confidence interval 0.12-0.79). CONCLUSION: Most ATs observed after artificial intelligence-guided, dispersion-based catheter ablation are targetable. The prevalence of these ATs and the repeat procedure rate are reduced when strategic completion of dispersion-based ablation was obtained.