Pulsed field ablation had a 6.7% repeat procedure rate at median 6.8 months, with pulmonary vein reconnection in 62% of patients and posterior wall reconnection in 70% among patients undergoing repeat procedures.
Observational (n=751)
Yes
3,199 patients undergoing index pulsed field ablation (PFA) for atrial fibrillation (AF), of which 708 underwent a repeat procedure for arrhythmia recurrence. The single-center cohort included 50 repeat procedure patients (median age 63, 38% female, 48% persistent AF).
Index pulmonary vein isolation (PVI) with or without posterior wall (PW) isolation using a pentaspline pulsed field ablation (PFA) catheter (Farapulse/Farawave), followed by repeat procedure for arrhythmia recurrence.
Incidence of repeat procedure and durability of pulmonary vein isolation (PVI) and posterior wall (PW) ablation at repeat procedure.
Real-world data and meta-analysis demonstrate that pulmonary vein and posterior wall durability is limited (reconnection rates >50%) in patients requiring repeat procedures after index pulsed field ablation for atrial fibrillation.
Effect estimate: Rate 6.7% at median 6.8 months
Limited real-world data exist regarding pulmonary vein (PV) and posterior wall (PW) durability after index pulsed field ablation (PFA) for atrial fibrillation (AF) in patients undergoing repeat procedure. We performed a single-centre retrospective observational study of consecutive patients who underwent repeat procedure for arrhythmia recurrence after index PFA for AF and a meta-analysis of published observational studies. All patients underwent index PV ± PW isolation with Farapulse/Farawave (Boston Scientific, US). Endpoints were incidence of repeat procedure and durability of PVI and PW ablation at repeat procedure. A meta-analysis was also performed evalutaing these endpoints following PFA with the same pentaspline catheter. Out of 751 index PFA procedure, 50 patients underwent repeat procedure (6.7%) at median 6.8 months (IQR 3.2–10.1). Arrhythmia recurrence was 48% AF, 36% AT/AFL and 16% both. Persistent AF at index ablation was associated with repeat procedure (p = 0.03). In 48 patients, PVs were durably isolated in 38%. Most common reconnection was RSPV (44%; 21/48), LSPV (40%; 19/48), RIPV (25%; 12/48) then LIPV (21%; 10/48). Superior PVs were more commonly reconnected than inferior PVs (p = 0.005). PW reconnection occurred in 70% (16/23). Meta-analysis of 6 further studies (n = 708) showed repeat procedure rate of 8.8% (95%CI 0.05–0.11). PVs were reconnected in 57% (95%CI 0.48–0.65) and PW reconnected in 55% (95%CI 0.39–0.71). These real world data and meta-analysis show limited PV and PW durability in patients with arrhythmic recurrence undergoing repeat procedure after PFA for AF. Additional procedural strategies are needed to enhance lesion durability from PFA.
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Ha et al. (Thu,) conducted a observational in Patients with paroxysmal or persistent atrial fibrillation undergoing index pulsed field ablation (n=751). Pulsed field ablation (PFA) was evaluated on Incidence of repeat ablation procedure for arrhythmia recurrence (Rate 6.7% at median 6.8 months). Pulsed field ablation had a 6.7% repeat procedure rate at median 6.8 months, with pulmonary vein reconnection in 62% of patients and posterior wall reconnection in 70% among patients undergoing repeat procedures.
synapsesocial.com/papers/69994c5d873532290d020c2e — DOI: https://doi.org/10.1007/s10840-026-02258-1
Francis J. Ha
Sarah Paitry
Duron Prinsloo
Monash Health
Journal of Interventional Cardiac Electrophysiology
Monash Health
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