Study limitations
For our main result — durability of the EIVM lesion — generalizability is limited by the small sample size, although the monocentric and consecutive enrollment and the follow-up data available for each patient limit the risk of biased selection. Second, assessment of scar area in the VOM region may have been limited by four main factors: 1) inaccuracy intrinsic to the area measurement tool of the CARTO system; 2) bipolar voltage measured in different atrial rhythms in some patients before, immediately after, and late after EIVM, although in a direction that may only result in underestimating the lesion size (AF to AT/SR or AT to SR); and 3) the impact of the associated RF lesions at the MI during the index procedure 4) absence of information of the epicardial scar related to EIVM.
Finally, due to the accuracy of the measure, we cannot confirm that the border of the EIVM created scar is always consistent.