Intraprocedural findings and outcomes of second redo-procedures after voltage-guided ablation of persistent atrial fibrillation

Abstract Introduction ERASE-AF study showed additional efficacy of low voltage guided ablation (VGA) beyond PVI in persistent AF cases. Recently we presented intraprocedural findings and good efficiency of a second VGA approach. The aim of the present study was to evaluate the efficacy of a re-redo-procedures after VGA in an exclusively persistent AF cohort. Methods Persistent AF cases who received their first AF ablation using VGA and CARTO3D between January 2015 and May 2022 were included in the Erfurt AF ablation registry. Patients receiving their first redo-ablation after VGA between January 2015 and August 2022 were included in our initial study. All patients out of the first analysis who received a second redo were included in the present study. Ablation was performed using Thermocool Smarttouch SFTM. Follow up after the second ablation procedure took place after 11 ± 4 months. Primary endpoint was freedom of recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) with and without drugs between 3 and 12 months follow up. Results Altogether, 676 persistent AF cases received a first VGA, 77 patients in turn a first redo-ablation which resulted in 12 months freedom of AF/AT of 69% (off drugs 61%). Eleven patients underwent a second redo (age 75 ± 5 years, female male sex in 73 %, LAESVI 48.3 ± 16.5 ml/m2, mean LVEF 56.7 ± 5.7 %, detailed data in table 1). In 6 of them the procedure took place within 12 months after the first redo ablation, in the other 5 of them after on average 25 ± 12 months. In 18% of the cases we saw reconnected PV (7% of PV), in 64% of patients reconnected lines could be identified. Progressive or new LVZs occurred in 54% of patients. Detailed analysis of intraprocedural findings and performed ablation concepts are displayed in table 2. The complication rate was 9% (1/11 pat.), including an AV block III° with the necessity of a temporary pacemaker probe. Rhythm monitoring included 72hours Holter ECG in six patients, 24 hours Holter ECG in one and 12 lead ECG in three patients. One patient died before 12 months follow up. The results showed a freedom of recurrence of 70% (n=10). The freedom of recurrence off drugs in turn was 50%. One patient died before the 12 months follow up. Conclusions Even though this study is limited by the small patient cohort, second redo procedures seem to have comparably good results. Reconnected lines and progressive LVZs are the relevant issues in patients with recurrences after a second VGA.Table 1 Table 2