{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T13:29:20Z","timestamp":1776259760514,"version":"3.50.1"},"reference-count":20,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Cardiology II, Rhythmology and Interventional Electrophysiology, R\u00d6HN Clinic Campus Bad Neustadt"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. Recently, a randomized study showed that adding voltage-guided ablation (VGA) in persistent AF cases was beneficial. The aim of the present study was to evaluate the safety, efficacy and predictors of success of redo procedures after VGA in an exclusively persistent AF cohort. Methods: Data are derived from the prospective Erfurt AF ablation registry. Starting in 2015, ablation procedures were performed using CARTO3D and VGA. Patients receiving their first redo procedure between 01\/2015 and 08\/2022 were included. Follow-up included 72 h Holter ECG or device interrogation, ECG, symptom-triggered event recording, and questioning at 3 and 12 months after the redo procedure. The primary endpoint was freedom of recurrence of AF or atrial tachycardia (AT) without drugs between 3 and 12 months. Results: Altogether, 683 patients received a first VGA between January 2015 and May 2022, and 77 patients had their first redo procedure occurring 20 \u00b1 17 months after the first procedure. During the first redo procedure, reconnected PVs were found in 44%, reconnected lines in 23% and new or progressive LVZs in 57% of patients. Complications occurred in two patients (2.6%). During follow-up one patient died, and one did not participate due to aphasia. It was found that 69% were free of recurrence and 61% were free of recurrence off drugs. Patients with recurrence were older than those without recurrence off drugs (73 \u00b1 6 versus 69 \u00b1 9 years, p = 0.049). Conclusions: Redo procedures after VGA in persistent AF have comparatively good results; although, many patients have progressive fibrosis.<\/jats:p>","DOI":"10.3390\/jcm15083005","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T12:25:30Z","timestamp":1776255930000},"page":"3005","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraprocedural Findings and Outcomes of Redo Procedures After Voltage-Guided Ablation of Persistent Atrial Fibrillation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0151-6305","authenticated-orcid":false,"given":"Maxi","family":"Hartmann","sequence":"first","affiliation":[{"name":"Department of Cardiology\/Interventional Electrophysiology, Helios Hospital Erfurt, Nordh\u00e4user Str. 74, 99089 Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duc","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Georg Klinikum Eisenach, M\u00fchlh\u00e4user Str. 94, 99817 Eisenach, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Violeta","family":"Mattea","sequence":"additional","affiliation":[{"name":"Department of Cardiology\/Interventional Electrophysiology, Helios Hospital Erfurt, Nordh\u00e4user Str. 74, 99089 Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Steinborn","sequence":"additional","affiliation":[{"name":"Department of Cardiology\/Interventional Electrophysiology, Helios Hospital Erfurt, Nordh\u00e4user Str. 74, 99089 Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mykhaylo","family":"Chapran","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Helios Frankenwaldklinik Kronach, Friesener Str. 41, 96317 Kronach, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Surber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Internal Intensive Care and Angiology, University Clinic Jena, Am Klinikum 1, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kourosh","family":"Vathie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Helios Klinikum Meiningen, Bergstra\u00dfe 3, 98617 Meiningen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Assani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Klinikum Bad Hersfeld, Seilerweg 29, 36251 Bad Hersfeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussam","family":"Hamo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Helios Klinikum Bonn\/Rhein-Sieg, Von-Hompesch-Stra. 1, 53123 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamzeh","family":"Alsous","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Diakonie Klinikum Jung-Stilling, Wichernstr. 40, 57047 Siegen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa C.","family":"Costello-Boerrigter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99438 Bad Berka, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens Martin","family":"Kittner","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Endocrinology, Diabetology and Rheumatology, Helios Hospital Erfurt, Nordh\u00e4user Str. 74, 99089 Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Lauten","sequence":"additional","affiliation":[{"name":"Department of Cardiology\/Interventional Electrophysiology, Helios Hospital Erfurt, Nordh\u00e4user Str. 74, 99089 Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9442-7141","authenticated-orcid":false,"given":"Christian","family":"Schulze","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Internal Intensive Care and Angiology, University Clinic Jena, Am Klinikum 1, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3846-7565","authenticated-orcid":false,"given":"Anja","family":"Schade","sequence":"additional","affiliation":[{"name":"Department of Cardiology II, Rhythmology and Interventional Electrophysiology, R\u00d6HN Clinic \u201cCampus Bad Neustadt\u201d, Von-Gutteberg-Stra\u00dfe 11, 97616 Bad Neustadt a. d. Saale, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/jce.15764","article-title":"Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta-analysis","volume":"34","author":"Moustafa","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1161\/CIRCEP.113.001251","article-title":"Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation","volume":"7","author":"Rolf","year":"2014","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/jce.14387","article-title":"Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information","volume":"31","author":"Huo","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1002\/clc.23677","article-title":"The efficacy and safety of left atrial low-voltage area guided ablation for recurrence prevention compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation trial: Design and rationale","volume":"44","author":"Sunaga","year":"2021","journal-title":"Clin. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e005405","DOI":"10.1161\/CIRCEP.117.005405","article-title":"STABLE-SR (Electrophysiological Substrate Ablation in the Left Atrium During Sinus Rhythm) for the Treatment of Nonparoxysmal Atrial Fibrillation: A Prospective, Multicenter Randomized Clinical Trial","volume":"10","author":"Yang","year":"2017","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1093\/europace\/euv131","article-title":"Towards durable pulmonary vein isolation: We are closing the gap","volume":"17","author":"Duytschaever","year":"2015","journal-title":"Europace"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s10840-020-00882-z","article-title":"Voltage-guided ablation in persistent atrial fibrillation-favorable 1-year outcome and predictors","volume":"62","author":"Schade","year":"2021","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e007005","DOI":"10.1161\/CIRCEP.118.007005","article-title":"Feasibility, Safety, and Efficacy of Posterior Wall Isolation During Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis","volume":"12","author":"Thiyagarajah","year":"2019","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"euad299","DOI":"10.1093\/europace\/euad299","article-title":"Dynamic changes of left atrial substrate over time following pulmonary vein isolation: The Progress-AF study","volume":"25","author":"Marcon","year":"2023","journal-title":"Europace"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.hroo.2022.07.013","article-title":"Personalized assessment of the cumulative complication risk of the atrial fibrillation ablation track: The AF-TRACK calculator","volume":"3","author":"Bisbal","year":"2022","journal-title":"Heart Rhythm O2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/jce.14867","article-title":"Repeat catheter ablation for recurrent atrial fibrillation: Electrophysiologic findings and clinical outcomes","volume":"32","author":"Daimee","year":"2021","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.hrthm.2023.12.003","article-title":"Repeat catheter ablation for atrial fibrillation","volume":"21","author":"Brahier","year":"2024","journal-title":"Heart Rhythm"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/jce.13434","article-title":"Repeat ablation or medical management alone for recurrent arrhythmias after ablation of persistent atrial fibrillation","volume":"29","author":"Barakat","year":"2018","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s10840-019-00666-0","article-title":"Clinical and electrophysiological characteristics predicting the re-ablation outcome for atrial fibrillation patients","volume":"59","author":"Miao","year":"2020","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1111\/jce.16266","article-title":"Left atrial low-voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures","volume":"35","author":"Georgi","year":"2024","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/europace\/euq434","article-title":"Predictors of recurrence following radiofrequency ablation for persistent atrial fibrillation","volume":"13","author":"McCready","year":"2011","journal-title":"Europace"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1111\/jce.13322","article-title":"Persistency of left atrial linear lesions after radiofrequency catheter ablation for atrial fibrillation: Data from an invasive follow-up electrophysiology study","volume":"28","author":"Lip","year":"2017","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ijcard.2022.10.013","article-title":"High-power short-duration versus low-power long-duration ablation guided by the ablation index","volume":"370","author":"Sousa","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/jce.16123","article-title":"High-power short-duration versus low-power long-duration ablation for pulmonary vein isolation: A substudy of the AWARE randomized controlled trial","volume":"35","author":"Joza","year":"2024","journal-title":"J. Cardiovasc. Electrophysiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3005\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T12:37:02Z","timestamp":1776256622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/3005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15083005"],"URL":"https:\/\/doi.org\/10.3390\/jcm15083005","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]}}}