AF Symposium 2026 - Repeat ablation strategies: Moving Beyond Pulmonary Vein Isolation and the Role of Advanced Mapping.

Dr Boris Schmidt (Cardioangiologisches Centrum Bethanien, Frankfurt, DE) and Dr Atul Verma (McGill University Health Centre & McGill University, Montreal, CA, US) discuss optimal approaches to redo atrial fibrillation ablation and the critical decision of when to extend beyond pulmonary vein isolation. The conversation explores strategies for identifying pulmonary vein reconnection, evaluating substrate modification techniques, and determining which patients may benefit from additional lesion sets beyond repeat PVI.

The discussion examines the common clinical scenario where pulmonary veins are found to be already isolated during a redo procedure, necessitating a move toward substrate-based mapping. The experts discuss the transition from empirical approaches to individualised strategies, such as targeting low-voltage areas and late atrial potentials identified while the patient is in sinus rhythm. They also evaluate the technical challenges of achieving bidirectional conduction block in linear lesions and how newer technologies, like dual-energy catheters and ethanol infusion, are shifting the procedural landscape.

Recorded on-site at AF Symposium 2026.

Editor: Jordan Rance
Videographer: Tom Green

Support: This is an independent interview produced by Radcliffe Cardiology.