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Related Experiment Video

Updated: Jun 13, 2026

Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation
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Impact of High-Density Mapping on Pulmonary Vein Isolation Durability: A Randomized, Single-Center Study.

Nina Kajdič1,2, Tine Prolič Kalinšek3, Bor Antolič2

  • 1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

Pacing and Clinical Electrophysiology : PACE
|May 6, 2025
PubMed
Summary

Eliminating low-voltage, fragmented electrograms (LFEGMs) during pulmonary vein isolation (PVI) using high-density mapping significantly improves PVI durability. This strategy enhances long-term procedural success in patients with paroxysmal atrial fibrillation.

Keywords:
PVI durabilityhigh‐density mappingparoxysmal atrial fibrillationradiofrequency catheter ablation

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Pulmonary vein (PV) reconnection remains a challenge despite advancements in ablation techniques.
  • High-density (HD) mapping offers novel insights into atrial electrograms.

Purpose of the Study:

  • To evaluate the impact of eliminating antral low-voltage, fragmented electrograms (LFEGMs) on pulmonary vein isolation (PVI) durability.
  • To compare PVI durability using HD mapping with additional LFEGM ablation versus standard circumferential mapping.

Main Methods:

  • Sixty patients with paroxysmal atrial fibrillation (PAF) were randomized into two groups: HD mapping with LFEGM ablation or standard circumferential mapping.
  • Pulmonary vein (PV) entrance block and LFEGMs were assessed using HD or circumferential mapping catheters.
  • A mandatory reassessment was performed at 12 months to evaluate PVI durability and LFEGM presence.

Main Results:

  • The HD group showed a significantly higher rate of durable PV isolation (92.2%) compared to the circumferential mapping group (80.8%).
  • The HD group had significantly fewer LFEGMs at reassessment (7 vs. 34).
  • Eliminating LFEGMs reduced the likelihood of conduction gaps and did not significantly alter arrhythmia recurrence rates.

Conclusions:

  • Additional ablation of LFEGMs identified by HD mapping significantly enhances PVI durability.
  • HD mapping with LFEGM elimination is a promising strategy for improving long-term success in PVI procedures.