Incidence of durably isolated PVs during repeat AF ablation
Previous studies have shown a variable incidence of durably isolated PVs
in patients with AF recurrence presenting for repeat AF ablation.
Reconnection rates may vary dependent on the study population, operator
experience and the ablation technique. The chance of all veins being
durably isolated increases with the number of previous PVI
procedures.(16,17) A sub-analysis of the FIRE AND ICE trial examining
findings at repeat ablation procedures, indicated a higher incidence of
durably isolated PVs following cryoballoon ablation compared to
radiofrequency ablation (21.9% vs. 17.3%).(18) Recent studies and
meta-analyses have shown that incidence rates range between
15-40%.(1,10–12) However, a contemporary study by De Potter et al.
reported a much higher incidence of 62%, potentially attributable to
the CLOSE-guided ablation strategy used during the index ablation, which
involves precise delivery of contact-force guided point-by-point
radiofrequency ablation.(11) In the past years, novel ablation
technologies such as pulsed field ablation have been introduced, which
may lead to different lesion durability.(19) Data from two recently
published large multicenter registries, the EU-PORIA registry and the
MANIFEST registry, observed that 38% and 45.5% of patients,
respectively, had durably isolated PVs at repeat ablation after initial
PVI with pulsed field ablation.(20,21) Thus, with the development of
novel ablation approaches and techniques the number of patients with
durably isolated PVs during repeat procedures may increase.