INTRODUCTION
Despite notable improvements in the efficacy of pulmonary vein isolation (PVI) through advancements of ablation strategies and technologies, recurrences of atrial fibrillation (AF) after PVI still persist in up to 25-50% of patients.(1–6) At repeat ablation procedures, pulmonary vein (PV) reconnection is often observed.(1,7–9) In these patients the primary objective of repeat ablation interventions remains re-isolation of the PVs.
Recent studies have shown that 15-40% of patients undergoing repeat ablation for AF recurrence appear to have all PVs durably isolated on electrophysiological mapping.(1,10–12) Despite the high incidence, limited evidence is available and no expert consensus exists on the optimal ablation strategy in patients with durably isolated PVs. This has led to a wide array of operator-dependent approaches such as linear ablation lesions, low-voltage area ablation and trigger ablation,.(10,13) Therefore, we conducted a nation-wide comparison of the effectiveness and safety of various real-world ablation strategies used during repeat AF ablation in patients with durably isolated PVs in the Netherlands, utilizing data from the Netherlands Heart Registration.