Key result
Focal pulsed field ablation achieves ~76% long-term pulmonary vein isolation durability at repeat mapping.
Why the study?
Focal pulsed field ablation shows encouraging acute outcomes for pulmonary vein isolation, but the long-term durability of PVI and more complex linear lesions remains incompletely defined.
Does focal pulsed field ablation provide durable pulmonary vein isolation and linear lesions at repeat ablation in patients with recurrent atrial arrhythmias?
Cohort (n=40)
No
Does focal pulsed field ablation provide durable pulmonary vein isolation and linear lesions at repeat ablation in patients with recurrent atrial arrhythmias?
In patients requiring repeat ablation after focal pulsed field ablation, long-term lesion durability was moderate overall (76% for PVI and 38%–83% for various linear lesions), highlighting the need for improved lesion optimization when treating complex atrial tachycardias.
Moderate durability of linear lesions after focal PFA warrants caution; hypothesis-generating for optimization in prospective trials.
Background Focal pulsed field ablation (FPFA) has emerged as a promising modality for atrial lesion creation, with encouraging acute remapping outcomes for pulmonary vein isolation (PVI). However, the long-term durability of PVI and more complex linear lesions remains incompletely defined. Methods We identified all consecutive patients who underwent FPFA using the Centauri system for atrial arrhythmias at our institution and subsequently required a clinical repeat procedure with high-density multi-electrode mapping (n=40). FPFA was performed as a first procedure in 11 patients and as a second or subsequent procedure in 29 patients. Lesion durability was assessed at repeat ablation using high-density electroanatomical mapping and pacing maneuvers. Lesions were categorized by type and analyzed accordingly. Clinical recurrence during follow-up was defined as any documented atrial tachycardia or initiation/escalation of antiarrhythmic drug therapy. Results Mean age was 67 ± 8 years. The predominant presenting arrhythmia at repeat ablation was atrial flutter (32/40, 80%). Mean procedure time was 107 ± 37 minutes. In total, 125 lesions were evaluated at repeat ablation, performed a mean of 359 ± 229 days after the index FPFA procedure. Durability rates were: PVI 57/75 (76%), posterior wall isolation 12/18 (67%), cavotricuspid isthmus line 10/12 (83%), anteroseptal mitral isthmus line 3/8 (38%), and other linear lesions 6/12 (50%). After a mean follow-up of 289 ± 268 days, 30 patients (75%) remained free from clinical recurrence. Conclusions In this selected cohort undergoing repeat ablation for recurrent atrial arrhythmias, including complex atrial tachycardias, FPFA demonstrated moderate long-term lesion durability. Improved substrate characterization, optimization of lesion overlaps, and better understanding of lesion depth and procedural limitations with FPFA are needed to enhance long-term durability and clinical outcomes.
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Ruwald et al. (2026) conducted a cohort in Recurrent atrial arrhythmias including complex atrial tachycardias (n=40). Focal pulsed field ablation (FPFA) using the Centauri system was evaluated on Lesion durability at repeat ablation (pulmonary vein isolation). Focal pulsed field ablation showed moderate long-term durability at repeat mapping, achieving 76% durability for PVI, 83% for cavotricuspid isthmus, and 67% for posterior wall isolation.
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