The Lead Episode 123: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion – The RESTART Trial, Live at HRX 2025-Speaker Information: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion

Speaker Information: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion – The RESTART Trial

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The RESTART trial investigates re-ablation strategies for atrial fibrillation (AF) by targeting electrogram dispersion to improve outcomes after initial ablation failure. Hosted by Dr. Tina Baykaner of Stanford University, the discussion convened contributors including Drs. Paul C. Zei (Brigham and Women’s Hospital) and Jerome Kalifa (Volta Medical), among others involved in the study, published in the Heart Rhythm Journal. The trial focuses on using electrogram dispersion mapping to identify AF substrates and guide more precise and effective re-ablation treatment.<br /><br />The panel emphasized the challenges posed by recurrent AF following initial ablation, highlighting the need for better targeting strategies to improve procedural success. Electrogram dispersion analysis aims to identify regions of non-uniform atrial electrical activity that sustain arrhythmia, providing a novel substrate for targeted ablation beyond conventional pulmonary vein isolation. The multidisciplinary contributors detailed the methodology, clinical implications, and outcome measures assessed in RESTART, including safety and efficacy in reducing AF recurrence.<br /><br />Disclosures were noted: Dr. Kalifa holds stock options in Volta Medical and has consulting relationships with device companies such as Biosense Webster and Abbott. Dr. Zei disclosed clinical expertise with no major conflicts, while Dr. Baykaner reported honoraria from multiple medical device companies as well as NIH-funded research. The discussion underscored the promising potential of electrogram dispersion-guided re-ablation but also called for further studies to validate widespread clinical application.<br /><br />In summary, the RESTART trial represents a significant step toward improving treatment for recurrent AF by employing advanced electrogram mapping to identify ablation targets, potentially enhancing procedural success and patient outcomes.

Keywords

RESTART trial

atrial fibrillation

re-ablation strategies

electrogram dispersion

atrial substrate mapping

arrhythmia treatment

pulmonary vein isolation

clinical outcomes

ablation failure

electrophysiology