Pulmonary Vein Reconnection Patterns After Pulsed-Field Ablation: Exploratory Insights from Repeat Procedures Across Three Platforms

Background Pulsed-field ablation (PFA) platforms for pulmonary vein isolation (PVI) vary in catheter design, energy-delivery configuration, and contact-assessment capabilities. Whether these differences translate into distinct pulmonary vein (PV) reconnection patterns during repeat procedures remains unclear. Objective To describe the anatomical distribution of PV reconnection during repeat procedures after PFA-based PVI across three PFA platforms. Methods This single-center retrospective study included 35 patients who underwent repeat procedures after index PVI for atrial fibrillation using FARAPULSE (FP, n=9), PulseSelect (PS, n=18), or VARIPULSE (VP, n=8). Reconnection sites were classified by PV and anatomical segment. In VP-treated patients, gaps were assessed in relation to index-procedure tissue proximity indication (TPI) status and the electrode 1–10 gap. Results In this selected repeat-procedure cohort, complete durable PVI was observed in 3 (33.3%), 8 (44.4%), and 0 (0%) FP-treated, PS-treated, and VP-treated patients, respectively (P = 0.07). Reconnection occurred most often at the anterior right PV carina, followed by the left superior PV; left inferior PV reconnection was uncommon. No FP- or VP-treated patient had more than two reconnected PVs, whereas 4 PS-treated patients (22.2%) had reconnection of ≥3 PVs. Among VP-treated patients, 72.0% of gaps were associated with TPI-negative regions or involved the electrode 1–10 gap, where bipolar PFA energy was not delivered directly. Conclusions PV reconnection after PFA was most frequently observed at the anterior right PV carina across three PFA platforms.