AIMS: RECOVER AF evaluated the performance of whole-chamber non-contact charge-density mapping to guide the ablation of non-pulmonary vein (PV) targets in persistent atrial fibrillation (AF) patients following either a first or second failed procedure. METHODS AND RESULTS: RECOVER AF was a prospective, non-randomized trial that enrolled patients scheduled for a first or second ablation retreatment for recurrent AF. The PVs were assessed and re-isolated if necessary. The AF maps were used to guide the ablation of non-PV targets through elimination of pathologic conduction patterns (PCPs). Primary endpoint was freedom from AF on or off antiarrhythmic drugs (AADs) at 12 months. Patients undergoing retreatment with the AcQMap System (n = 103) were 76% AF-free at 12 months [67% after single procedure (SP)] on or off AADs (80% free from AF on AADs). Patients who had only received a pulmonary vein isolation (PVI) prior to study treatment of non-PV targets with the AcQMap System were 91% AF-free at 12 months (83% SP). No major adverse events were reported. CONCLUSION: Non-contact mapping can be used to target and guide the ablation of PCPs beyond the PVs in persistent AF patients returning for a first or second retreatment with 76% freedom from AF at 12 months. The AF freedom was particularly high, 91% (43/47), for patients enrolled having only a prior de novo PVI, and freedom from all atrial arrhythmias for this cohort was 74% (35/47). These early results are encouraging and suggest that guiding individualized targeted ablation of PCPs may therefore be advantageous to target at the earliest opportunity in patients with persistent AF.

Cardiac Electrophysiology Department Asklepios Klinik St Georg Hamburg Germany

Cardiology and Cardiothoracic Surgery Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK

Cardiology Department Freeman Hospital Newcastle Upon Tyne UK

Cardiology Department Sint Antonius Hospital Nieuwegein The Netherlands

Cardiology Department The James Cook University Hospital Middlesbrough UK

Department Cardiology and Angiology Klinikum Coburg Coburg Germany

Department of Cardiology Erasmus Medical Center Rotterdam Rotterdam The Netherlands

Department of Cardiology Homolka Hospital Prague Czech Republic

Department of Cardiology Royal Brompton Hospital London UK

Department of Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge UK

Department of Electrophysiology Heart Center University of Cologne Cologne Germany

Division of Cardiology McGill University Health Centre McGill University Montreal QC Canada

Heart Rhythm Management Centre Cardiovascular Division UZ Brussel Vrije Universiteit Brussel Brussels Belgium

Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Headley Way Oxford OX3 9DU UK

R and D Algorithms Acutus Medical Carlsbad CA USA

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