What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (AF) (n=339). Intervention: Pulsed field ablation (PFA). Primary outcome: Arrhythmia recurrence after a blanking-period of 90 days.

What question did this study set out to answer?

The research aims to evaluate the long-term outcomes and predictors of atrial fibrillation recurrence after pulmonary vein isolation using pulsed field ablation.

June 27, 2026Open Access

Long-term outcome, predictors of AF-recurrence and findings during redo-procedures after pulmonary vein isolation with Pulsed Field Ablation

Key Result

During a median follow-up of 752 days after pulsed field ablation for pulmonary vein isolation, 34% of patients experienced arrhythmia recurrence, with electrical cardioversion predicting higher risk.

Key Points

The research aims to evaluate the long-term outcomes and predictors of atrial fibrillation recurrence after pulmonary vein isolation using pulsed field ablation.
Conducted a retrospective analysis of 339 patients treated with pulsed field ablation for atrial fibrillation.
Analyzed 55 redo procedures following initial pulmonary vein isolation with a pentaspline PFA catheter.
Examined the association of electrophysiological findings and ablation strategies with recurrence outcomes.
34% of patients experienced arrhythmia recurrence after the blanking-period of 90 days, with a median recurrence time of 218 days.
Electrical cardioversion and the presence of atrial fibrillation at the first procedure were significant predictors of recurrence (HR 1.97, p=0.011; HR 1.73, p=0.034).
47% of veins were found reconnected during redo procedures, indicating frequent reconnections, especially on the anterior aspect.

Study Design

Type

Cohort (n=339)

Multicenter

Structured PICO

What are the long-term outcomes and predictors of arrhythmia recurrence after pulmonary vein isolation with pulsed field ablation in patients with atrial fibrillation?

Population

339 patients (63% paroxysmal AF, 37% persistent AF) who underwent first pulmonary vein isolation with a pentaspline pulsed field ablation catheter, followed for a median of 752 days.

Exposure

Pulmonary vein isolation (PVI) using a pentaspline pulsed field ablation (PFA) catheter.

Outcome

Arrhythmia recurrence after a blanking-period of 90 days.hard clinical

Pulsed field ablation for PVI shows a 34% recurrence rate over a median 2-year follow-up, with PV reconnections frequently observed at redo procedures, though a multiple procedure approach yields 80% long-term arrhythmia-free survival.

Abstract

Abstract Background Pulsed field ablation (PFA) is an established technology for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). However, besides some data on recurrent arrhythmias and electrophysiological findings during redo procedures after PFA, data on long-term outcome remain scarce. Methods We conducted a retrospective analysis of our single-centre data of 339 patients (63% paroxysmal AF, 37% persistent AF), as well as of 55 redo procedures in patients, who underwent first PVI with a pentaspline PFA catheter. We provide first data on long-term outcome and report electrophysiological findings and ablation strategies during redo procedures. Results During the median FUP of 752 (391-1486) days, 116 out of 339 patients (34%) experienced arrhythmia recurrence after a blanking-period of 90 days, with a median time to recurrence of 218 (90-1161) days. Multivariate analysis showed electrical cardioversion at the end of the first procedure HR 1.97 (95% CI 1.17–3.33), p=0.011 and AF at the beginning of the procedure HR 1.73 (95% CI 1.04-2.88), p=0.034 being independently associated with a higher risk of arrhythmia recurrence. Additional anterior flower applications were protective in the univariate (p=0.025) analysis. Atrial tachycardia (AT) as recurrent arrhythmia was present in 16%/37%/0%/0% after first/second/third/fourth procedure. In 55 analysed redo procedures 104/221 veins (47%) were reconnected at the redo procedure (0/1/2/3/4 reconnected veins: 9%/31%/27.3%/27.3%/5.4%). Analysis of multiple procedure outcome estimates improved long-term arrhythmia-free survival, with an overall recurrence rate of 21% after two (84.1%), three (11.2%) or four (4.7%) procedures Conclusion PV reconnections are frequent in patients presenting for repeat ablations, especially at the anterior PV aspect. A multiple procedure approach estimates arrhythmia-free survival in 80% of patients. Procedures with additional anterior lesions at the RPV’s could be protective for recurrences.Graphical Abstract

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