Pulsed-field ablation versus radiofrequency ablation in patients undergoing repeat catheter ablation for atrial fibrillation

Background Pulsed-field ablation (PFA) is noninferior compared with thermal energy sources such as radiofrequency ablation (RFA) or cryoballoon ablation for de novo pulmonary vein isolation (PVI). However, its potential value for repeat catheter ablation (CA) after unsuccessful thermal PVI has not been assessed. Objective This study aimed to compare the procedural characteristics, safety, and efficacy between PFA and RFA in patients undergoing repeat CA after previous thermal PVI. Methods Patients with recurrent atrial fibrillation (AF) undergoing repeat CA at a tertiary referral center were prospectively enrolled. All redo procedures were guided by a 3-dimensional electroanatomic mapping system and performed using either PFA or RFA. Results A total of 185 patients underwent repeat CA for AF (median age 68 years [60–74], 31% female, 53% paroxysmal AF, and 47% persistent AF). PFA was used in 71 patients (38%), whereas RFA was used in 114 patients (62%). The median procedure time was similar between the PFA and RFA groups (61 minutes [50–71] vs 56 minutes [45–82] P = .956), whereas fluoroscopic time was longer in the PFA group (8 minutes [6–12] vs 4 minutes [2–8], P < .001). A total of 4 complications occurred, all in the RFA group. Recurrence-free survival rates after repeat CA were 61% and 69% in the PFA vs the RFA group after a follow-up of 365 days (Plog-rank = .082). Posterior wall isolation was more commonly performed in the PFA group (72% vs12%). Conclusion In patients undergoing repeat CA after thermal PVI, PFA resulted in similar procedural characteristics, safety, and arrythmia-free survival compared with RFA.