Work

Repeat procedures after pulsed field ablation for atrial fibrillation: tertiary centre experience and meta-analysis of observational studies

Year: 2026

Type: review

Abstract: BACKGROUND: Limited real-world data exist regarding pulmonary vein (PV) and posterior wall (PW) durability after index pulsed field ablation (PFA) for atrial fibrillation (AF) in patients undergoing repeat procedure. METHODS: We performed a single-centre retrospective observational study of consecutive patients who underwent repeat procedure for arrhythmia recurrence after index PFA for AF and a meta-analysis of published observational studies. All patients underwent index PV ± PW isolation with Farapulse/Farawave (Boston Scientific, US). Endpoints were incidence of repeat procedure and durability of PVI and PW ablation at repeat procedure. A meta-analysis was also performed evalutaing these endpoints following PFA with the same pentaspline catheter. RESULTS: Out of 751 index PFA procedure, 50 patients underwent repeat procedure (6.7%) at median 6.8 months (IQR 3.2–10.1). Arrhythmia recurrence was 48% AF, 36% AT/AFL and 16% both. Persistent AF at index ablation was associated with repeat procedure (p = 0.03). In 48 patients, PVs were durably isolated in 38%. Most common reconnection was RSPV (44%; 21/48), LSPV (40%; 19/48), RIPV (25%; 12/48) then LIPV (21%; 10/48). Superior PVs were more commonly reconnected than inferior PVs (p = 0.005). PW reconnection occurred in 70% (16/23). Meta-analysis of 6 further studies (n = 708) showed repeat procedure rate of 8.8% (95%CI 0.05–0.11). PVs were reconnected in 57% (95%CI 0.48–0.65) and PW reconnected in 55% (95%CI 0.39–0.71). CONCLUSIONS: These real world data and meta-analysis show limited PV and PW durability in patients with arrhythmic recurrence undergoing repeat procedure after PFA for AF. Additional procedural strategies are needed to enhance lesion durability from PFA.

Source: Journal of Interventional Cardiac Electrophysiology

DOI: 10.1007/s10840-026-02258-1