Efficacy of high-power short-duration radiofrequency ablation in arrhythmia burden-driven redo pulmonary vein isolation: a prospective study

Background Repeat pulmonary vein isolation (PVI) is commonly performed to improve outcomes in patients with atrial fibrillation (AF). Although pulmonary vein reconnection remains a major cause of recurrence, the optimal energy delivery strategy for reisolation has not been clearly established. Methods We prospectively evaluated redo PVI procedures performed using point-by-point radiofrequency ablation. Patients underwent either ablation index-guided low-power long-duration (LPLD; 25–35 W) or high-power short-duration (HPSD; 50/90 W) ablation. Procedural parameters, periprocedural complications, and 12-month arrhythmia-free survival were compared. Multivariate logistic regression was used to identify independent predictors of arrhythmia recurrence. Results A total of 170 redo PVI procedures were analysed (LPLD, n = 46; HPSD, n = 124). Total procedure time (130.3 ± 9.3 vs 139.3 ± 6.9 min, p = 0.16), ablation time (96.7 ± 8.5 vs 100.0 ± 6.3 min, p = 0.57), fluoroscopy time (7.1 ± 2.0 vs 7.3 ± 0.9 min, p = 0.85), and radiation dose (575.9 ± 182.8 vs 394.0 ± 110.9 cGy·cm², p = 0.09) were similar between groups. Organised post-PVI atrial tachycardia occurred in 28.3% and 24.2% of patients, respectively (p = 0.59). No major complications occurred in the LPLD group, while one case of cardiac tamponade was reported in the HPSD group (p = 0.22). At 12 months, arrhythmia-free survival was 73.9% in the LPLD group and 81.5% in the HPSD group (p = 0.28). Larger left atrial diameter (per 5 mm; OR 1.61, 95% CI 1.20–2.20, p = 0.0019) and older age (per 10 years; OR 1.76, 95% CI 1.14–2.88, p = 0.016) independently predicted arrhythmia recurrence. Conclusions In repeat PVI procedures, HPSD ablation demonstrated comparable procedural efficiency and clinical efficacy to LPLD ablation. Larger left atrial diameter and older age were independent predictors of arrhythmia recurrence after redo PVI.