From CHAMPION-AF to clinical reality: pulmonary vein reconnection patterns after cryoballoon versus pulsed field ablation

Background Single-shot ablation technologies, mainly cryo-balloon (CB) and pulsed field ablation (PFA), are increasingly favored for first-time PVI due to their procedural efficiency and ability to achieve rapid, safe, and durable PVI. However, comparative data on PVI durability and reconnection pattens in large real-world cohorts remain limited. Methods We retrospectively analyzed patients undergoing first-time PVI at a high-volume German center between 2021 and 2025. Re-mapping findings during repeat ablation after index PFA-PVI were compared with those after index CB-PVI. Results Among 1,961 patients (CB: n=1,369; PFA: n=592), baseline characteristics were similar between groups (age: 67 [59–74] vs. 67 [60–74] years, p=0.72; female sex: 39% vs. 36%, p=0.06; persistent AF: 53.9% vs. 54.4%, p=0.88; LVEF: 47±11% vs. 48±10%). Repeat ablation was performed in 169/1,369 (12.3%) CB patients and 35/592 (5.9%) PFA patients (p value < 0.001). Complete isolation of all PVs at repeat procedure was more frequent after PFA (45.7% vs. 22.5%, p=0.01). The mean number of reconnected PVs was higher in the CB group (1.54 ± 1.16 vs. 0.74 ± 0.82). Left-sided PV reconnection rates were comparable (LSPV: 23.1% vs. 17.1%, p=0.51; LIPV: 27.2% vs. 25.7%, p>0.99), whereas right-sided PV reconnections were significantly lower with PFA for both RSPV and RIPV (RSPV: 50.3% vs. 14.3%, p<0.001; RIPV: 48.5% vs. 14.3%, p<0.001). Conclusion In repeat ablation after previous PFA- or CBA-based PVI, PFA is associated with reduced reconnection rates, specifically in the right pulmonary veins compared with cryoablation.