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AF Re-Ablation: A Comparative Analysis of the Efficacy of Initial PVI Procedures
Session:
SESSÃO DE POSTERS 53 - FIBRILHAÇÃO AURICULAR E ARRITMIAS AURICULARES COMPLEXAS
Speaker:
João Reis Sabido
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
João Reis Sabido; Catarina Gregório; Daniel Inácio Cazeiro; Ana Abrantes; Ana Bernardes; Joana Brito; Afonso Nunes Ferreira; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Various ablation modalities have been explored to perform pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Studying the patterns of pulmonary vein (PV) reconnection in redo procedures can provide insights into the lesion durability of these modalities, potentially leading to technical advancements.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong> To compare the effectiveness of various ablation modalities for PVI by assessing the occurrence of PV reconnection in redo procedures.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Single-center, retrospective study of patients who underwent AF redo ablation from 2015 to November 2024. Redo procedure mapping was performed with high-density electroanatomic systems (Carto, Ensite, Rhythmia) to search for PV reconnection and the presence of low-voltage areas in various left atrial walls.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 264 patients were included (70% male, 62±11 years old, 55.3% paroxysmal AF). The first ablation procedure was performed with Point-by-Point radiofrequency (RF) in 100 pts (38%), PVAC in 64 (25%), cryoablation in 96 (37%), pulsed field ablation in 3 pts, and surgical ablation in one. Substrate mapping revealed complete PV isolation in only 13% of the pts, with reconduction of at least one PV in the remaining 87%. Compared to other techniques, cryoablation was more effective in achieving sustained PVI, showing higher rates of persistent PVI of 2 or 3 PVs (p=0.008) – Fig 1, although there was no difference in the pts that had all the PVs isolated – Fig 2. Additionally, cryoablation was associated with a higher percentage of persistent left superior, left inferior, and right inferior PV isolation (p=0.038, 0.001, and 0.003, respectively), compared to PVAC and RF, with no differences regarding the left pulmonary trunk (Fig 1). In a detailed analysis of each ablation technique, it was observed that with cryoablation, the right superior PV was the least likely vein to be isolated during the redo procedure (p=0.001), whereas no pattern was observed with other modalities. Low-voltage areas outside of the PV antrum were documented in 31% of the pts, more frequently in the anterior wall (64%). Of these, substrate modification was performed in 83%. Furthermore, non-PV triggers were mapped in 13 pts (9 in the left atrium and 4 in the right atrium).</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> Most of the patients who underwent AF redo procedures showed PV reconnection, highlighting the need for a more efficient technique for first PVI. When compared to other ablation modalities, cryoablation showed higher rates of durable PV isolation.</span></span></span></p>
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