Journal Article Ahead of print
PubMed: 41017375 DOI: 10.1111/jce.70117
Functional Gaps and Atrial Fibrosis as Predictors of Early Arrhythmia Recurrence After Robotic-Enhanced Hybrid Ablation for Persistent Atrial Fibrillation.
J Cardiovasc Electrophysiol
Authors: Eduardo Celentano, Ernesto Cristiano, Erika Bertella, Matteo Parrinello, Giovanni Albano, Barbara Ignatiuk, Martina Renda, Elena Bia, Anthea d'Amico, Raffaele Rainone, Ascanio Graniero, Laura Giroletti, Laura Polini, Mario Gasparri, Stefano Schena, Alfonso Agnino, Natasja M S De Groot
Affiliations
- Department of Electrophysiology, Humanitas Gavazzeni, Bergamo, Italy.
- Unit Translational Electrophysiology, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Cardiac Imaging, Humanitas Gavazzeni, Bergamo, Italy.
- Department of Anesthesiology, Humanitas Gavazzeni, Bergamo, Italy.
- Department of Minimally Invasive and Robotic Cardiac Surgery, Humanitas Gavazzeni, Bergamo, Italy.
- Department of Management, Information and Production Engineering of the University of Bergamo, Dalmine, Bergamo, Italy.
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Abstract
BACKGROUND
Robotic-enhanced hybrid ablation (RE-HA) is a promising strategy for persistent (PsAF) and long-standing persistent atrial fibrillation (LS-PsAF). The impact of post-epicardial conduction gaps and atrial fibrosis on early arrhythmia recurrence (EAR) is unclear.
OBJECTIVE
To assess whether conduction gaps and atrial fibrosis predict EAR within 3 months after the epicardial stage of RE-HA.
METHODS
Forty-two PsAF/LS-PsAF patients underwent RE-HA with left atrial appendage closure. High-density endocardial mapping at 3 months identified fixed (present in all maps) and functional (present in ≥1 but not all maps) conduction gaps. Atrial fibrosis was quantified by pre-procedural cardiac magnetic resonance (CMR).
RESULTS
Gaps were found in 18 patients (42.3%): functional in 10 (23.8%) and fixed in 13 (31.0%), with 5 (12%) showing both. EAR occurred in 12 patients (28.6%), AFL in 10/12 (83.3%). Gaps predicted AFL (OR 4.56; p = 0.003) and EAR (OR 3.50; p = 0.005). Left atrium LGE ≥ 10% independently predicted EAR (OR 7.50; p = 0.019) with no interaction with gap presence (p = 0.24). Total RF time was similar between groups despite more gaps in recurrence cases, reflecting procedural factors beyond gap count. Roof-line gaps predominated and colocalized with epicardial fat on CMR.
CONCLUSION
Delayed high-density mapping after RE-HA reveals fixed and functional conduction gaps, especially at the roof line, that-together with pre-ablation fibrosis-independently predict EAR. These findings highlight distinct anatomical and electrophysiological risk domains and support substrate assessment with targeted endocardial completion in a staged workflow.
MeSH
Fibrosis, Arrhythmias, Cardiac, Ear, Atrial Fibrillation