Preventive Linear Ablation Strategy for Intra‐Atrial Reentrant Tachycardia Following Cardiac Surgery

ABSTRACT Aims Intra‐atrial reentrant tachycardia (IART) frequently occurs following cardiac surgery due to scar‐related conduction abnormalities. While advances in mapping technologies have improved the acute success rate of catheter ablation, arrhythmia recurrence remains a significant clinical concern. This study aimed to evaluate whether a preventive linear ablation strategy guided by voltage mapping improves the long‐term success rate of catheter ablation in patients with IART post‐cardiac surgery. Methods and Results A total of 46 consecutive patients following cardiac surgery who underwent atrial tachycardia ablation between 2022 and 2024 were enrolled in the study group. After activation mapping‐guided ablation for ongoing IART, preventive linear ablation was performed based on voltage mapping. Fifty consecutive sex‐ and age‐matched patients with cardiac surgery undergoing activation mapping‐guided ablation alone served as the historical control group between 2018 and 2021. At a mean follow‐up of 21 ± 4.9 months, the rate of freedom from atrial arrhythmias was significantly higher in the study group compared to the control group (82.6% vs. 64.0%; p = 0.019). Despite the improved outcomes, the study group had significantly longer total procedure times (192 ± 37 vs. 126 ± 25 min; p < 0.001) and radiofrequency ablation durations (29 ± 5 vs. 20 ± 6 min; p < 0.001). However, there were no significant differences in complication rates between the two groups. Conclusions Preventive linear ablation strategy was associated with improved arrhythmia‐free survival in patients with IART post cardiac surgery, but these exploratory findings require confirmation in future prospective studies.