Early recurrence after pulsed field ablation was associated with lower 12-month freedom from recurrence compared to no early recurrence (29.0% vs 82.5%; HR 7.9; 95% CI 4.1-15.1; P<0.001).
Cohort (n=169)
Does early recurrence of atrial fibrillation after pulsed field ablation predict late recurrence in patients with paroxysmal atrial fibrillation?
Early recurrence of atrial fibrillation within the 90-day blanking period after pulsed field ablation is strongly predictive of late recurrence at 12 months.
Hazard Ratio: 7.9 (95% CI 4.1–15.1)
Absolute Event Rate: 29% vs 82.5%
p-value: p=<0.001
AIMS: Studies have shown correlations between early recurrence (ER) and late recurrence (LR) of atrial arrhythmia after ablation with thermal technologies. This admIRE trial (NCT05293639) subanalysis aims to analyse ER vs. LR in patients with paroxysmal atrial fibrillation (PAF) undergoing pulsed field ablation (PFA). METHODS AND RESULTS: Patients with symptomatic paroxysmal atrial fibrillation and ≥1 transtelephonic monitoring transmission during the blanking period were included (n = 169). ER was defined as documented recurrence in the blanking period (days 1-90), and LR as recurrence in the evaluation period (days 91-365). Freedom from 12-month recurrence was estimated using Kaplan-Meier method. A Cox proportional-hazards regression model, with ER as the primary factor, and adjusted for age, sex, and body mass index, was used to estimate hazard ratios (HRs) and 95% CI. ER was observed in 20.1% (31/169) of patients (66.1 ± 7.1 years, 35.5% female, 46.6 ± 48.4-month PAF history). Time to first documented ER was 49 (37-61) days. Occurrence of LR was 16.7% (23/138) in patients without ER, 71.0% (22/31) in those with ER, and 87.0% (20/23) in patients whose ER onset occurred within the first 2 months. Twelve-month freedom from documented recurrence was significantly lower in patients with ER at 29.0% (95% CI, 13.1-45.0%) vs. 82.5% (95% CI, 75.9-89.1%) in those without ER (adjusted HR, 7.9; 95% CI, 4.1-15.1; P < 0.001). CONCLUSION: This admIRE subanalysis demonstrated that PAF patients who experience ER after PFA are at a substantially higher risk for LR. The optimal duration of the blanking period post-PFA needs further assessments. CLINICALTRIALS.GOV IDENTIFIER: NCT05293639.
Biase et al. (2025) conducted a cohort in Paroxysmal atrial fibrillation (n=169). Early recurrence of atrial arrhythmia vs. No early recurrence was evaluated on 12-month freedom from documented recurrence (HR 7.9, 95% CI 4.1-15.1, p=<0.001). Early recurrence after pulsed field ablation was associated with lower 12-month freedom from recurrence compared to no early recurrence (29.0% vs 82.5%; HR 7.9; 95% CI 4.1-15.1; P<0.001).