Impact of high-density mapping on outcome of the second ablation for atrial fibrillation



Identification of a conduction gap between the left atrium and pulmonary vein (LA-PV gap) and the circuit of atrial tachycardia after pulmonary vein isolation (PVI) is an important process during the second ablation for atrial fibrillation (AF). The high-density mapping system RHYTHMIA® is useful for identification of an LA-PV gap and the circuit of atrial tachycardia. Therefore, this study was performed to investigate the effect of RHYTHMIA® in terms of the outcome of the second ablation for AF.


One hundred patients underwent a second ablation for AF in our institute from April 2015 to December 2018. We retrospectively evaluated 49 patients using RHYTHMIA® (group 1) and 51 patients using the conventional method with additional anatomical guide by CARTO® system.


In group 1, we performed redo PVI for 41 patients with 49 LA-PV countable gaps and ablation for other atrial arrhythmias in 7 patients. In group 2, we performed redo PVI in 40 patients with 33 LA-PV countable gaps and ablation for other atrial arrhythmias in 9 patients. Three and two unstable arrhythmias in each group were not ablated. The final recurrence of atrial arrhythmia was significantly lower in group 1 than 2 (8/49 (16%) vs. 17/51 (33%), respectively; P = 0.017). Atrial arrhythmias other than AF after the second ablation occurred in only one patient in group 1 but seven patients in group 2.


Using high-density mapping for the second ablation of AF was found to be superior to the conventional ablation method in terms of the suppression of atrial events in this study. This technique warrants further investigation.

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R Kato supervised research design and details. S Iwanaga confirmed whether all echo cardiographic assessment was properly performed. R Kato, K Goto, T Nagase, H mori, and Y Ikeda joined as major ablation operators. H Mori, K Tsutsui, S Tanaka, S Asano, M Tawara, M Yukino, and S Hasegawa cooperated in collecting data. S Nakano, T Muramatsu, and K Matsumoto approved this article.

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Correspondence to Ritsushi Kato.

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The authors declare that they have no conflict of interest.

Ethical approval and informed consent

This study was approved as a retrospective study by the institutional review board of Saitama Medical University, International Medical center (18–226). An informed consent is not necessary in principle in a retrospective study. However, the information of this study is published on the homepage of our institution, and all study subjects have the opportunity to refuse participation in this study.

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Ikeda, Y., Kato, R., Mori, H. et al. Impact of high-density mapping on outcome of the second ablation for atrial fibrillation. J Interv Card Electrophysiol 60, 135–146 (2021).

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  • Atrial fibrillation
  • Catheter ablation
  • Cardiac electrophysiologic technique
  • Three-dimensional image