Clinical Impact of Interlesion Distance on Acute Pulmonary Vein Isolation Success in Patients With Paroxysmal Atrial Fibrillation
Year: 2026
Type: article
Abstract: Background: Achieving pulmonary vein isolation (PVI) through contiguous lesions is important for durable PVI treatment of atrial fibrillation (AF). We hypothesized that the flexible-tip TactiFlex catheter, with its enhanced stability, would allow for successful acute PVI even with an extended interlesion distance (ILD) of 6 mm. Methods and Results: The WILD (Wide ILD) PVI trial was a prospective, multicenter, single-blind randomized non-inferiority trial. A total of 94 patients with paroxysmal AF were enrolled and randomly allocated to either a wide ILD group (≤6 mm, n=52) or a standard ILD group (≤4 mm, n=42). The primary endpoint was acute PVI success, defined as first pass isolation without early reconnection. The non-inferiority margin was set at -10.0%. The 6-mm group did not meet the criteria for non-inferiority compared to the 4-mm group (56.7% vs. 68.7%; absolute difference: -11.9% [95% confidence interval: -25.7 to 1.8%]; P for non-inferiority=0.664). Conversely, the 6-mm strategy significantly reduced the total number of RF applications (47±10 vs. 73±17, P=0.001) and total ablation time (528±119 s vs. 825±233 s, P<0.001) compared to the 4-mm group. Conclusions: The 6-mm ILD strategy was inferior to the standard 4-mm strategy for acute PVI success. Despite significant gains in procedural efficiency, maintaining an ILD ≤4 mm is recommended to ensure high acute procedural success when using the TactiFlex catheter.
Source: Circulation Reports
Authors: Keika Oyama, Yoshihisa Naruse, Yuki Arakawa, Shuhei Kobayashi, Hironori Nakamura, Naruya Ishizue, Jun Kishihara, Hidehira Fukaya, Tomoaki Nagao, Natsuko Hosoya, Kohei Sawasaki, Masahiro Muto, Michitomo Kawahito, Yuki Tokonami, Kazuki Ito, Yutaro Kaneko, Taro Narumi, Makoto Sano, Yuichiro Maekawa
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7204173597