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Currently, there is limited evidence on the appropriate treatment strategy for these patients. We aimed to characterize and compare the effectiveness of different re-ablation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All patients referred for repeat AF ablation with all PVs durably isolated at 8\u00a0hospitals in the Netherlands were included [Netherlands-Heart-Registration (NHR); 2016\u20132019]. NHR data were were used to determine the presence of PV-reconnection, the ablation strategy used, and the outcome of ablation (atrial arrhythmia recurrence &gt;\u202f30\u202fsec.). The effectiveness of ablation strategies was assessed with multivariable Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2311 repeat AF ablations performed, 274 (11.9%) patients had all PVs durably isolated. Median age was 66 (IQR:58\u201370) years, 44.2% women, 45.6% had persistent\/long-standing-persistent AF. In 33 (12.0%) patients, no ablation was performed. A\u00a0single ablation strategy was performed most often (41.2%). Posterior wall ablation (58.4%) was performed most often, followed by PV-antralization (26.3%). Over 2.0 (1.0\u20133.3) years, 147 (59.8%) patients had an atrial arrhythmia recurrence, and 30 (12.7%) patients had another repeat AF ablation within 1\u00a0year. After multivariable adjustment, no difference in atrial-arrhythmia recurrences was detected between individual ablation strategies, number of strategies performed, and type of atrial-arrhythmia (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&gt;\u20090.05 for all). Left-atrial-volume-index was associated with a\u00a0higher recurrence-risk [aHR 1.03(95%CI 1.01\u20131.05)].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with durably isolated PVs, a\u00a0high proportion experienced recurrence of atrial arrhythmias, with no difference in recurrence rates between different re-ablation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12471-026-02021-1","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T10:11:34Z","timestamp":1770804694000},"page":"107-116","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Repeat ablation strategies in atrial fibrillation patients with durably isolated pulmonary veins: insights from the Netherlands Heart Registration"],"prefix":"10.1007","volume":"34","author":[{"given":"Federico Tancredi","family":"Magni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Samuel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart A.","family":"Mulder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"van der Stoel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rutger J.","family":"Hassink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serge A.","family":"Trines","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiel J. 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J.G.L.M.\u00a0Luermans is consultant for Medtronic and received research grants from Medtronic. J.S.S.G.\u00a0de Jong is consultant for Medtronic. M.\u00a0van der Stoel receives Honoria from American College of Cardiology Foundation. S.A.\u00a0Trines received teaching fees from Biosense Webster and consulting fees from Abbot (all to the department). The remaining authors have no conflicts of interests to declare. F.T.\u00a0Magni, M.\u00a0Samuel, B.A.\u00a0Mulder, R.J.\u00a0Hassink, M.J.B.\u00a0Kemme, J.C.\u00a0Balt and P.H.\u00a0van der Voort declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}