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

Area of Science:

• Electrophysiology
• Cardiac Ablation
• Arrhythmia Management

Background:

• Recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) is often attributed to PV reconnections.
• Limited data exists on the long-term durability of PVI and arrhythmia recurrence in persistent AF patients.

Purpose of the Study:

• To assess the durability of lesions created during CLOSE-guided PVI in persistent AF patients.
• To evaluate the incidence of pulmonary vein reconnections and arrhythmia recurrence using a planned remapping procedure.

Main Methods:

• Prospective study of patients with symptomatic persistent AF undergoing CLOSE-guided radiofrequency ablation.
• Mandatory redo procedure at 6 months post-ablation to assess PV reconnections, regardless of clinical recurrence.
• Clinical outcomes assessed by recurrence and 7-day Holter ECGs at multiple time points.

Main Results:

• Of 26 patients who underwent remapping, 76% of pulmonary veins (PVs) showed durable isolation, and 58% had complete isolation of all PVs.
• Arrhythmia recurrence occurred in 23% of patients before the redo procedure.
• After redo procedures, 65% of patients remained free of arrhythmia at 12 months.

Conclusions:

• CLOSE-guided PVI demonstrates a durable isolation rate of 76% per vein and 58% per patient in persistent AF.
• Arrhythmia recurrence was numerically higher in patients with durable PVI compared to those without, suggesting complex mechanisms beyond simple reconnections.