Post–pulmonary vein isolation voltage remapping–guided incremental lesions: A feasible strategy to improve long-term outcomes

Abstract

Background

Pulmonary vein isolation (PVI) has demonstrated acceptable success rates; however, there is still potential for improvement. Pulmonary reconnection remains the main problem and the role of adjunctive strategies, such as repeat mapping to guide additional lesions to enhance durability of pulmonary vein isolation, remains uncertain.

Objective

This study aimed to evaluate the impact of post-PVI high-density remapping with guided incremental lesions on long-term recurrence-free survival.

Methods

This study included consecutive patients who underwent PVI between 2015 and 2023. Patients were divided into 2 groups based on whether they received post-PVI high-density remapping. Those in the remapping group with documented areas of incomplete ablation received incremental lesions to achieve complete ablation. The primary endpoint was recurrence-free survival.

Results

A total of 588 patients, with a mean follow-up of 25.8 months, were included. Post-PVI remapping was performed in 243 patients, while 345 patients underwent conventional PVI. Post-PVI remapping with guided incremental lesions improved recurrence-free survival compared with conventional PVI (adjusted hazard ratio 0.75, 95% confidence interval [CI] 0.57-0.99, P = .04). This benefit was especially notable in patients with paroxysmal atrial fibrillation (hazard ratio 0.69, 95% CI 0.49-0.96, P = .027). Complication rates and procedure times were comparable between the 2 groups. For patients undergoing their first radiofrequency ablation, 1-year success was higher in those who underwent PVI remapping (adjusted odds ratio 1.70, 95% CI 1.04–2.77, P = .03). However, long-term outcomes were comparable between the 2 groups.

Conclusion

Postablation mapping effectively identifies and addresses proarrhythmic foci, potentially reducing atrial fibrillation recurrence and improving patient outcomes.