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.