Clinical Implication
AEPVR had the similar distribution and EGM characteristics as late epicardial PVR found in repeat procedures which was considered arrhythmogenic, indicating their common mechanism and the role in AF recurrence. The potential benefit of treating AEPVRs was reflected by the outcome showing no statistical difference between AEPVR and Control groups. According to the analysis, it is necessary to take the anatomic characteristics and multiple ablation-related parameters e.g., AI, impedance drop, inter-lesion distance into comprehensive consideration when evaluating the possibility of AEPVR. Although the duration for post-ablation waiting has been questioned[25], we recommend a 40-minute waiting period given the longer time for AEPVR to appear, especially when energy delivery has to be limited on the posterior wall. Based on the possibility late manifestation of ICB conduction, reconnection from the right carina to right atrium should be excluded after the observation period even in the absence of residual potentials when the circular ablation is completed.