Background:
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia and is associated with substantial morbidity and mortality. Over the past decade, three-dimensional (3D) mapping–guided radiofrequency ablation has become an established cornerstone in rhythm control strategies. Despite continuous technological advancements, the optimal method for confirming acute pulmonary vein isolation (PVI) remains a matter of debate. This study aimed to assess the diagnostic accuracy of pulmonary vein (PV) stimulation compared with 3D re-mapping following wide antral circumferential ablation (WACA).
Methods:
A total of 58 patients with paroxysmal or persistent AF who underwent bilateral WACA at the University Heart Center Ulm between November 2023 and April 2025 were included. Data collection was performed peri-interventionally. Following initial isolation, stimulation from each PV and carina was conducted with a maximum output of 20 mA. Stimulation was performed ostially, on the PV or carina side, and directly at the ablation line based on the baseline electroanatomical map. Subsequently, 3D re-mapping was performed to confirm PVI, and the results of both approaches were directly compared.
Results:
The median age was 73 years [IQR 62.75–78.25], and the median body mass index (BMI) was 26.85 [IQR 24.05–29.86]. The mean left atrial diameter was 4.8 [IQR 4.35–5.55] cm. Advanced atrial fibrosis was observed in 19 patients (33%). For the left PVs, a higher rate of false-negative results was found with stimulation alone (LSPV: p = 0.039; LIPV: p = 0.012). In contrast, stimulation was generally sufficient for the right PVs (RSPV: p = 0.344; RIPV: p = 1.000). A significant difference was also observed at the left carina (p = 0.002) compared with the right (p = 0.453).
Conclusion:
These findings indicate that, particularly for the left PVs and the left carina, the complementary use of 3D re-mapping is essential to ensure complete and durable PVI. For the right PVs, stimulation alone often provides sufficient confirmation. Both techniques should therefore be regarded as complementary tools that collectively enhance the acute verification of complete pulmonary vein isolation. Further validation in larger, prospective studies is warranted.
