This thesis of Federico Magni aimed to address these limitations by identifying patients for whom PVI-only approaches are insufficient, evaluating real-world outcomes of current re-ablation strategies in these patients, and assessing novel technologies designed to improve AF ablation efficacy.
Findings highlight the persistent challenge of achieving durable PVI with thermal ablation, particularly in persistent AF, where risk of thermal injury and progressive atrial disease limit success rates. Importantly, the thesis also underscores that AF recurrence may occur despite durable PVI, implicating extra-pulmonary vein mechanisms. Current strategies to target these yield inconsistent results, emphasizing the need for improved approaches in advanced disease.
Two innovative ablation modalities were explored. Hybrid ablation demonstrated superior effectiveness in persistent AF but is constrained by higher procedural complexity and complication risk. Pulsed-field ablation (PFA), a non-thermal, tissue-selective technique, offers shorter procedure times, improved safety, and rapid adoption. While not proven superior to thermal ablation, PFA shows comparable efficacy and strong potential for improved long-term outcomes as technology advances.
In conclusion, while PVI remains effective for many patients, it is insufficient for those with persistent AF and underlying comorbities. Hybrid ablation and PFA represent major advancements in AF therapy, highlighting the need for continued innovation, tailored patient selection, and improved lesion durability to optimize outcomes.
