Arrhythmias & electrophysiology
Impact of Initial Extensive Ablation on Left Atrial Gaps During Redo Procedures and Subsequent Outcomes in Persistent Atrial Fibrillation
Authors' conclusion
In the redo AF ablation of the EARNEST-PVI trial, left atrial conduction gaps were more frequent in patients who underwent extensive linear ablation during the index procedure. While all gaps during redo were potentially arrhythmogenic, PV gaps alone were associated with recurrence after redo AF ablation.
Study context
- Population
- Persistent atrial fibrillation (AF) trial participants who underwent redo AF ablationof the 512 trial participants, those who underwent redo AF ablation
- Participants
- 115 participants
- Comparison
- Left atrial conduction gaps, the occurrence of left atrial tachycardias during redo procedures, and subsequent recurrences were compared between the PVI-alone redo group and the PVI-plus linear ablation redo group.
- PVI-alone redo groupn = 69
- PVI-plus linear ablation redo groupn = 46
Methodological detailsanalysis of redo AF ablation in the EARNEST-PVI trial
- Analysis of redo AF ablation in the EARNEST-PVI trial
Primary result
As reported in the abstract
Conduction gaps at redo · redo procedure
| Group | Value | Electrical pulmonary vein (PV) gaps | PV gaps | Gaps in left atrial linear lines | Gaps in both |
|---|---|---|---|---|---|
| PVI-alone redo group | 57% | 38 (57%) | |||
| PVI-plus linear ablation redo group | 19 (41%) | 10 (22%) | 11 (24%) |
Value
PVI-alone redo group57%
PVI-plus linear ablation redo group— not stated in the abstract
Electrical pulmonary vein (PV) gaps
PVI-alone redo group38 (57%)
PVI-plus linear ablation redo group— not stated in the abstract
PV gaps
PVI-alone redo group— not stated in the abstract
PVI-plus linear ablation redo group19 (41%)
Gaps in left atrial linear lines
PVI-alone redo group— not stated in the abstract
PVI-plus linear ablation redo group10 (22%)
Gaps in both
PVI-alone redo group— not stated in the abstract
PVI-plus linear ablation redo group11 (24%)
Further findings
Left atrial tachycardias during the redo session · more frequently observed in the PVI-plus group
P = 0.005
Associations of gaps with tachycardia and recurrence after redo
| Hazard ratio (95% CI) | P value | ||
|---|---|---|---|
| PV gaps alone | 0.54 (0.31–0.95) | P = 0.033 | |
| 0.20.5125Hazard ratio (log scale) |
- Left atrial tachycardias during the redo session — left atrial tachycardias observed or induced
- 19 left atrial tachycardias in 15 patients
- Associations of gaps with tachycardia and recurrence after redo: PV gaps alone were associated with subsequent recurrence after redo
Associations of gaps with tachycardia and recurrence after redo
- The occurrence of left atrial tachycardias was associated with gaps in linear lesions
Original publication
Impact of Initial Extensive Ablation on Left Atrial Gaps During Redo Procedures and Subsequent Outcomes in Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol. Published 2 June 2025. doi:10.
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