https://doi.org/10.1007/s00392-025-02625-4
1Helios-Klinikum Erfurt Allgemeine und Interventionelle Kardiologie und Rhythmologie Erfurt, Deutschland; 2Helios-Klinikum Erfurt Kardiologie & Internistische Intensivmedizin Erfurt, Deutschland; 3Helios-Klinikum Erfurt Abteilung für Rhythmologie und Invasive Elektrophysiologie Erfurt, Deutschland; 4Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 5HELIOS Klinikum Meiningen Innere Medizin I - Kardiologie Meiningen, Deutschland; 6Herz-Kreislauf-Zentrum Rotenburg a. d. Fulda Kardiologie / Angiologie und Intensivmedizin Rotenburg an der Fulda, Deutschland; 7Helios-Klinikum Erfurt 3. Medizinische Klinik – Kardiologie Erfurt, Deutschland; 8RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Rhythmologie und Interventionelle Elektrophysiologie Bad Neustadt a. d. Saale, Deutschland
Introduction: ERASE-AF study showed additional efficacy of low voltage guided ablation (VGA) beyond PVI in persistent AF cases. Recently we presented intraprocedural findings and good efficiency of a second VGA approach.
The aim of the present study was to evaluate the incidence, intraprocedural findings and efficacy of second redo-procedures after VGA in an exclusively persistent AF cohort.
Methods: Starting in 2015, ablation procedures for persistent AF were generally performed using CARTO3D and VGA. All patients were included in the Erfurt AF ablation registry. Patients receiving their first redo-ablation after VGA between January 2015 and August 2022 were included in our initial study. All patients out of the first analysis who received a second redo were included in the present study. Regular follow up (FU) took place after 3 and 12 months. Primary endpoint was freedom of recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) between 3 and 12 months FU.
Results: Altogether, 676 persistent AF cases received a first VGA, 77 patients in turn a first redo-ablation which resulted in 12 months freedom of AF/AT of 69% (off drugs 61%). 11 patients underwent a second redo (age 75 ± 5 years, female sex in 73 %, LAESVI 48.3 ± 16.5 ml/m2, mean LVEF 56.7 ± 5.7 %, detailed data in table 1). The procedure took place 18 ± 12 months after the first redo ablation.
In 18% of the cases we saw reconnected PV. In 64% of the patients reconnected lines could be identified. Progressive or new LVZs occurred in 54% of patients. Detailed analysis of intraprocedural findings and ablation concepts are displayed in table 2.
The complication rate was 9%, including a transitory AV block III° with the necessity of a temporary pacemaker probe.
FU after second ablation procedure took place after 11 ± 4 months. Rhythm monitoring included 72 hours Holter ECG in 6 patients, 24 hours Holter ECG in 1 and 12 lead ECG in 3 patients. One patient died before 12 months follow up. The results showed a freedom of recurrence of 70%. The freedom of recurrence off drugs in turn was 50%.
Conclusions: Even though this study is limited by the small patient cohort, second redo procedures seem to have comparably good results. Reconnected lines and progressive LVZs are the relevant issues in patients with recurrences after a second VGA.
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|
|
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Age (years) |
75 ± 5 |
|
Female (%) |
73 |
|
BMI (Kg/m²) |
29.1 ± 4.9 |
|
Short persistent (%) |
100 |
|
Cardiomyopathy (EF < 55 o. HCM) (%) |
9 |
|
Arterial hypertension (%) |
91 |
|
GFR (ml/min/1.7) |
66.5 ± 13.5 |
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Ejection fraction (%) |
56.7 ± 5.7 |
|
LAESVI (ml/m²) |
48.3 ± 16.5 |
Table 1) Basic parameters of patients undergoing re-redo procedure
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|
|
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Reconnected PV of applied PV (%) |
6.8 |
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Reconnected lines of applied lines (%) |
42.1 |
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New LVZ (%) |
9.1 |
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Progressive LVZ (%) |
45.4 |
|
PVI only % of patients |
9.1 |
|
LVZ only ablation % of patients |
72.7 |
|
PVI + LVZ ablation % of patients |
9.1 |
|
Other additional ablations (%) |
9.1 |
Table 2) Procedural data of re-redo procedures