Mechanistic vs. empirical ablation of atria during repeat ablation for atrial arrhythmias despite effective pulmonary vein isolation.

The management of atrial arrhythmia recurrence during repeat catheter ablation procedure is unclear despite persistent pulmonary vein isolation. It should be clarified whether an induced non-PV trigger-based (mechanistic) ablation approach more focusing on low-voltage zones is more effective compared to an empirical ablation of low-voltage zones via linear lesions during repeat ablation procedures. The operators should catch all triggers if possible rather than messing with the substrate.