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.