Arrhythmic substrate in pulmonary vein isolation reprocedures in the era of the close protocol

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The CLOSE protocol was developed as a radiofrequency ablation strategy that would result in the safe creation durable pulmonary vein isolation (PVI) leading to improved outcomes. aim is enclose PVs with stable, contiguous and index (AI) guided lesions. Purpose We analyze arrhythmic substrate found patients undergoing PVI reprocedure after first CLOSE-PVI procedure compare it observed who underwent non-CLOSE-PVI procedure. Methods Patients PVI-reprocedure (35W, AI 450 for anterior wall 350 posterior wall) were prospectively included (CLOSE-group). During detailed electroanatomical map multielectrode catheters obtained all patients. number reconnected segments assessed. In left atrial flutter (AFl), circuit defined by activation entrainment mapping. These data compared those historic control group reprocedures (non-CLOSE-group; 21 among 157 procedures). Results Among 352 CLOSE-PVI, 27 (74.1% male, 57±8.6 years) reprocedure. 74% (20 patients) showed at least 1 PV vs 100% non-CLOSE group; p=0.012. 7 without reconnection (PVR) perimitral AFl 2 roof dependent patient. remaining 4 no specific or trigger observed. showing PVR, differences terms mean [2(1-2) 2(1-3) respectively; p=0.751] 2(2-4) p=0.895) group. Conclusion PVR remains main fibrillation (AF) CLOSE-PVI. However, significantly higher proportion persistent AF; which makes necessary define new strategies improve rhythm these