Faculty Collaboration Database

Functional Gaps and Atrial Fibrosis as Predictors of Early Arrhythmia Recurrence After Robotic-Enhanced Hybrid Ablation for Persistent Atrial Fibrillation. J Cardiovasc Electrophysiol 2025 Dec;36(12):3173-3183

Date

09/29/2025

Pubmed ID

41017375

DOI

10.1111/jce.70117

Scopus ID

2-s2.0-105017397144 (requires institutional sign-in at Scopus site)

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.

Author List

Celentano E, Cristiano E, Bertella E, Parrinello M, Albano G, Ignatiuk B, Renda M, Bia E, d'Amico A, Rainone R, Graniero A, Giroletti L, Polini L, Gasparri M, Schena S, Agnino A, De Groot NMS

Authors

Mario G. Gasparri MD Professor in the Surgery department at Medical College of Wisconsin
Stefano Schena PhD, MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Action Potentials
Aged
Atrial Fibrillation
Atrial Remodeling
Catheter Ablation
Electrophysiologic Techniques, Cardiac
Female
Fibrosis
Heart Atria
Heart Rate
Humans
Male
Middle Aged
Predictive Value of Tests
Recurrence
Risk Assessment
Risk Factors
Robotic Surgical Procedures
Time Factors
Treatment Outcome