Electrographic Flow-Guided Mapping and Ablation in Redo AF Patients: 1-Year Outcomes of the RESOLVE-AF Clinical Trial

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Heart Rhythm

Abstract

Introduction: Current ablation strategies in redo AF patients often rely on empiric lesion sets. Electrographic flow (EGF) mapping is a diagnostic tool that spatiotemporally reconstructs and interprets AF wavefront propagation patterns. It can identify active sources of excitation for targeted ablation and estimate the health of the atrial substrate by measuring Electrographic Flow Consistency (EGFC). The current analysis studied EGF mapping outcomes in redo ablation patients. Methods: RESOLVE-AF (NCT05883631) enrolled patients planned for redo AF ablation to perform EGF-guided mapping and ablation. Following any requisite PV touchup, EGF maps were generated from 1-min recordings with a 64-pole basket catheter (OptiMap). At physician discretion, AF sources were ablated by focal radiofrequency energy. High EGFC was defined as a biatrial mean .0.5. Follow-up with ECGs and/or 7-day Holters took place at 3M, 6M and 12M post-procedure, as well as at other symptomatic visits. Primary effectiveness was 12M freedom from AF (FFAF). Results: Two hundred two patients were enrolled at 25 US/EU centers: age 6769 years, 31% female, LA diameter 3.961.9 cm, AF duration 8.166.2 years and 39% ≥2 prior ablations. PV reconnections were present and treated in 61%. AF was spontaneous or inducible in 154 patients with 2.861.8 sources identified per patient, 55% in the left atrium. Procedure time was 136654 min with 1466 min for EGF mapping. There were 2 (1.3%) procedure-related SAEs. Of 127 patients who completed 12M follow-up, 98 had all sources ablated, while 29 had remaining sources post-procedure. One-year FFAF was 66% (65 of 98) when all sources were ablated vs. 41% (12 of 29) when active sources were remaining, p50.016. Similarly, freedom from AF/AFL/AT was 58% (57 of 98) vs. 28% (8 of 29), p50.004. Patients with high EGFC had 67% (59 of 88) FFAF vs. 43% (18 of 39) with low EGFC, p50.026. Application: Successful ablation of EGF sources in redo AF patients results in a 25% absolute increase in FFAF without a tradeoff for increased AFL/AT. EGFC adds prognostic information beyond source presence. Next Steps/Future: Large randomized controlled trials of EGF with pulsed field ablation in de novo and redo populations.

Volume

23

Issue

4 Suppl

First Page

S327

Comments

Heart Rhythm Society Annual Meeting, April 23-26, 2026, Chicago, IL

Last Page

S328

DOI

10.1016/j.hrthm.2026.03.1847

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