Multicenter retrospective evaluation of a patient-tailored electrogram-based ablation strategy using an artificial intelligence software in repeat atrial fibrillation ablation procedures
Authors: Figus F , Deisenhofer I , De Potter T , Smit J J , Busch S , Lepillier A , Lacotte J , Gitenay E , Monteau J , Ayari A , Martinez Lombard E , Siame S , Bars C , Seitz J 
Published: May 2024

Abstract

Background
While pulmonary vein isolation (PVI) is the gold standard approach of treatment of atrial fibrillation (AF), the optimal strategy in case of AF recurrences for redo patients is not well established. Several studies described the usefulness of ablating in atrial regions exhibiting abnormal electrograms, i.e. spatio-temporal dispersion, during AF and an artificial intelligence (AI) electrograms (EGMs)-based software solution has been developed and validated to obtain real-time adjudications of multipolar electrograms in de novo patients.

Purpose
This study sought to evaluate the novel AI-EGMs-based software approach for redo-AF ablation procedures.

Methods
This study was a retrospective, multicentric, nonrandomized study. Patients with recurrent symptomatic AF were enrolled in 7 European centers. Redo ablation procedures were performed using the AI software and acute and long-term outcomes after ablation were evaluated.

Results
A total of 117 patients with refractory symptomatic AF admitted for redo procedure were included with 30% paroxysmal, 42% short-standing persistent and 28% long-standing persistent AF at the time of the redo procedure. During the index procedures, a previous PVI ablation was performed in all patients while additional ablation such as lines and EGM-based ablation was performed in 64 patients (55%). Out of 117 patients, 30 (26%) presented with structural heart disease, 61 (52%) with hypertension, 31 (26%) with a BMI &gt;30, 16 (14%) a sleep apnea syndrome and 24 (20%) had an antiarrhythmic treatment at the time of the procedure. The average AF history was 6.54 ± 4.15 years with an average sustained duration equal to 25 ± 62 months. AI-EGMs-based AF ablation was performed in all patients and easily integrated in the physicians’ workflow during redo procedures. AF termination, i.e. AF regularization or sinus rhythm conversion, occurred in 82/117 patients (71%) with sinus rhythm conversion by ablation in 79/117 patients (68%). After a mean follow-up of 11 ± 5 months, 81% of patients were free from documented AF, with or without antiarrhythmic drugs (AADs) after one redo procedure and 60% of patients were free from any documented atrial arrhythmia, with or without AADs, after one redo procedure per patient. Furthermore, we observed that 77%, 84% and 82% of patients were free from documented AF with or without AADs in paroxysmal, short-standing and long-standing persistent AF patients respectively, and that 71%, 59% and 49% of patients were free from any documented atrial arrhythmia with or without AADs in paroxysmal, short-standing and long-standing persistent AF patients respectively.

Conclusions
This retrospective study reports that patient-tailored spatiotemporal dispersion ablation is a relevant and standardized approach for repeat AF ablation. This was obtained with an AI-EGMs-based software solution, which may be added to the operative workflow of redo AF procedures.