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June 27, 2026EP EuropaceOpen Access

High-density mapping-guided ablation shows no benefit over empirical linear ablation for preventing sustained left atrial flutter.

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Why the study?

Does high-density mapping-guided ablation prevent recurrent sustained left atrial flutter at one year in patients with confirmed left atrial flutter compared to empirical linear ablation?

Population

56 patients ≥18 years with confirmed left atrial flutter, mean age 72.8 ± 14.0 years and 75.3 ± 8.2…

Comparison

High-density mapping-guided (HDM) ablation vs Empirical linear ablation including anteroseptal…

Design

RCT, randomized, open-label

Follow-up

1 year

Key result

High-density mapping-guided ablation did not significantly improve 1-year freedom from sustained left atrial flutter compared to empirical linear ablation (71.3% vs 50.5%; p=0.248).

Authors

JGJ Saldana GarciaSCS CastrejonCZC Zapata

Discussion

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Overview

HDM did not significantly improve freedom from sustained LAF; leaves open benefit in larger RCTs.

Key Points

  • The trial aims to compare the effectiveness of high-density mapping-guided ablation and empirical linear ablation in preventing recurrent sustained left atrial flutter.
  • Single-center, prospective, randomized, open-label superiority trial
  • Patients ≥18 years with confirmed left atrial flutter were randomized to either high-density mapping-guided ablation or empirical linear ablation
  • Daily ECG rhythm monitoring was conducted for one year follow-up.
  • Ablation procedural success was similar between groups: 65.5% (HDM) vs 66% (ELA).
  • At 1-year follow-up, the cumulative freedom from sustained LAF was 71.3% for HDM and 50.5% for ELA (p=0.248).
  • Overall complication rates were low and comparable, with no significant group differences.

Study Design

Type

RCT (n=56)

Blinding

Open-label

Randomization

Randomized

Multicenter

No

Structured PICO

Does high-density mapping-guided ablation prevent recurrent sustained left atrial flutter at one year in patients with confirmed left atrial flutter compared to empirical linear ablation?

P
Population
56 patients ≥18 years with confirmed left atrial flutter, without prior LAF ablation, randomized to HDM-guided or empirical linear ablation and followed for 1 year.
I
Intervention
High-density mapping-guided (HDM) ablation
C
Comparator
Empirical linear ablation (ELA) including anteroseptal and anterolateral mitral lines, roof line, posterior line (between pulmonary veins), anterosuperior wall line, and the cavotricuspid isthmus line
O
Outcome
Recurrent sustained left atrial flutter (≥30 seconds) at one yearhard clinical

Main Result

Absolute Event Rate: 71.3% vs 50.5%

p-value: p=0.248

In an interim analysis, high-density mapping-guided ablation showed a non-significant trend toward higher 1-year freedom from left atrial flutter recurrence compared to empirical linear ablation, with significantly shorter radiofrequency time.

Limitations

  • Limited sample size of this interim analysis

Cite This Study

Garcia et al. (2026) conducted an RCT in Left atrial flutter (LAF) (n=56). High-density mapping-guided ablation vs. Empirical linear ablation was evaluated on Freedom from recurrent sustained LAF (≥30 seconds) at one year (p=0.248). High-density mapping-guided ablation did not significantly improve 1-year freedom from sustained left atrial flutter compared to empirical linear ablation (71.3% vs 50.5%; p=0.248).

synapsesocial.com/papers/6a3f97ce125782b61d8659bdhttps://doi.org/10.1093/europace/euag105.194
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