Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-180 - Clinical Impact Of Wide Antral Circumferential Ablation And Antral Re-isolation In Case Of Recurrent Atrial Fibrillation After Prior Pulmonary Vein Isolation (ID 1047)


Background: Pulmonary vein isolation (PVI) has been an established cornerstone therapy in symptomatic atrial fibrillation (AF) patients. However, AF recurrence after PVI remains still not ignorable. Despite repeated PVI (re-PVI) has been also a standard procedure, the detailed methodology in case of re-PVI remains disputable.
Objective: The aim of this study was to assess the efficacy of wide antral circumferential ablation (WACA) for recurrent AF after PVI as compared to simple repeated PVI.
Methods: We consecutively enrolled patients with recurrent AF after PVI who underwent high-density (HD) left atrial mapping and subsequently WACA antral isolation. The historical controls with re-PVI between 2016 and 2018 without HD mapping were also enrolled. These control patients underwent re-PVI with gap ablation at the pulmonary vein ostium without HD left atrial mapping. Primary endpoint was defined as any recurrence and ECG documentation of atrial tachyarrhythmias (AT) including AF or atrial tachycardias over 30 seconds. The patients were routinely followed up for 1 year with at least twice annual holter monitoring.
Results: As a WACA re-PVI group, 36 patients were enrolled (68±9 years , 22 male), and as a control group 69 patients were enrolled (66±10 years, 46 male). There were no significant differences in clinical characteristics in both groups including the number of previous left atrial ablation procedures. During a mean follow-up period of 340±65 days, 3 out of 36 WACA re-PVI patients (8%) and 18 out of 69 controls (26%) experienced AT recurrences. In all 36 patients with HD left atrial mapping, residual PV antral potentials were demonstrated, in which 20 patients (56%) showed no electrical potentials inside PVs. Kaplan-Meier analysis demonstrated that the patients who underwent WACA re-PVI showed significantly lower recurrence of AF after the index procedure as compared to the controls (log-rank, P = 0.035).
Conclusion: The patients with recurrent AF after previously performed PVI show high incidence of residual pulmonary vein antral potentials. Repeated isolation of PV antrum (Re-WACA) is significantly effective to reduce further AF recurrence as compared to simple re-PVI without high density left atrial mapping.