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

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

Back to course

Video Transcription

Video Summary

The Restart trial, discussed by Drs. Paul Zai, Jerome Khalifa, and Tina Baconer, was a prospective, single-arm, multi-center study evaluating AF ablation in patients with prior ablation and symptomatic recurrence. Enrolling 213 patients mostly in the U.S., the trial used the Volta Medical system leveraging AI-enabled mapping of electrograms to identify areas sustaining AF. Patients with reconnected pulmonary veins were excluded, and 96 completed the Volta-guided procedure. Results showed 85% freedom from AF and 71% freedom from any arrhythmia, with quality of life significantly improved. Key limitations included its single-arm design, selective patient enrollment, and varied rhythm monitoring. The panel emphasized the need for tailored strategies to address AF mechanisms rather than empirical ablations like posterior wall isolation, highlighting AI’s role in rapid, detailed mapping. Future challenges include reducing procedure times and validating the approach against anatomical strategies, especially using emerging technologies such as pulsed field ablation to enhance efficiency and safety.

Keywords

Restart trial

AF ablation

Volta Medical system

AI-enabled mapping

pulsed field ablation