Identifying arrhythmogenic substrates is critical for improving outcomes after repeat atrial fibrillation ablation. This study was presented at the European Society of Cardiology Congress 2025. 

A retrospective analysis of 124 patients who underwent repeat ablation after failed pulmonary vein isolation examined unipolar and bipolar voltage metrics to predict atrial tachycardia and arrhythmia recurrence over 15 months. Low voltage areas were quantified using high-density mapping and analyzed with machine learning models. Patients with arrhythmia recurrence demonstrated significantly higher unipolar low voltage areas. Incorporating both unipolar and bipolar metrics improved prediction accuracy and ROC-AUC compared to single metrics.

These findings suggest that unipolar voltage mapping captures critical structural remodeling not fully reflected by bipolar mapping alone. Integrating both approaches could enhance procedural planning and risk stratification, supporting more targeted ablation strategies in patients with recurrent atrial fibrillation.