Durability of CLOSE-Guided Pulmonary Vein Isolation in Persistent Atrial Fibrillation: A Prospective Remapping Study

Oskar M Galuszka; Samuel H Baldinger; Helge Servatius; Jens Seiler; Antonio Madaffari; Nikola Kozhuharov; Gregor Thalmann; Thomas Kueffer; Aline Muehl; Jens Maurhofer; Andreas Haeberlin; Fabian Noti; Hildegard Tanner; Tobias Reichlin; Laurent Roten

doi:10.1016/j.jacep.2024.02.026

Durability of CLOSE-Guided Pulmonary Vein Isolation in Persistent Atrial Fibrillation: A Prospective Remapping Study

JACC Clin Electrophysiol. 2024 Apr 1:S2405-500X(24)00172-5. doi: 10.1016/j.jacep.2024.02.026. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
³ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: Laurent.Roten@insel.ch.

PMID: 38639700
DOI: 10.1016/j.jacep.2024.02.026

Abstract

Background: Recurrence of paroxysmal atrial fibrillation (AF) following pulmonary vein isolation (PVI) is presumably caused by pulmonary vein (PV) reconnections. However, there is little data available on the durability of PVI and incidence of arrhythmia recurrence in patients with persistent AF.

Objectives: To evaluate the lesion durability by means of an a priori planned remapping procedure in patients with persistent AF undergoing CLOSE-guided PVI.

Methods: In a prospective study, we included patients with symptomatic, persistent AF undergoing CLOSE-guided radiofrequency ablation. Irrespective of AF recurrence, a redo procedure was mandated 6 months following the index procedure to evaluate PV reconnections. The outcome of AF ablation was based on clinical recurrence and 7-day Holter electrocardiogram 3 and 6 months after the index procedure and 3, 6, and 12 months after the redo procedure.

Results: Of 30 patients included, 26 (81% men; median age 68 years) underwent the planned remapping study a median of 6 months after the index procedure, whereas 4 patients without recurrence refused a repeat procedure. In total, 78 of 102 (76%) PVs showed durable isolation and 15 patients (58%) presented complete isolation of all PVs. Beyond the blanking period, 6 of 26 patients (23%) had arrhythmia recurrence before the redo procedure. Recurrence had occurred in 33% of patients with complete isolation of all veins and in 9% of patients with PV reconnections (P = 0.197). After re-PVI in patients with PV reconnections and additional ablation in patients with recurrence but durable PVI, 17 of 26 patients (65%) were free of arrhythmia after 12 months.

Conclusions: In patients with persistent AF, CLOSE-guided PVI resulted in durable rate of PVI on a per-vein and per-patient level of 76% and 58%, respectively. Arrhythmia recurrence was numerically higher in patients with durable PVI compared with patients without.

Keywords: persistent atrial fibrillation; pulmonary vein isolation; radiofrequency catheter ablation; remapping study.