Characteristics of pulmonary vein reconnection sites across three pulsed-field ablation systems: findings from repeat procedures
Y Kitami, T Kamakura, D Shako, T Ikee, S Oka, A Wakamiya, N Ueda, K Nakajima, K Nakasuka, M Wada, K Ishibashi, Y Inoue, K Miyamoto, T Aiba, K KusanoAbstract
Background
Pulsed-field ablation (PFA) catheters currently available for pulmonary vein isolation (PVI) include a pentaspline catheter (FARAPULSE [FP]) and two circular catheters (PulseSelect [PS] and VARIPULSE [VP]). Although all three systems achieve high rates of acute PVI, differences in catheter design and energy delivery may influence lesion durability. However, comparative data on pulmonary vein (PV) reconnection patterns across platforms remain limited.
Purpose
We compared the incidence and distribution of PV reconnection at repeat procedures after index PVI using three PFA catheter platforms.
Methods
This single-centre retrospective study included 31 patients (median age 60 years [interquartile range [IQR], 51–76 years]; 16 women) who underwent repeat procedures after index PVI for atrial fibrillation using PFA (FP, n=8; PS, n=16; VP, n=7) (Table). PV reconnection was evaluated at the repeat procedure using a three-dimensional mapping system (CARTO 3 or EnSite X).
Results
At the index procedure, all PVs were successfully isolated using PFA alone. The median time from index to repeat procedure was 163 days (IQR 100–256 days). Complete durable PVI at repeat procedure was observed in 25.0% of patients treated with FP, 37.5% treated with PS, and 0% treated with VP (p = 0.20). Across platforms, PV reconnection gaps were most frequently located at the anterior carina of the right PV, followed by the left superior PV, whereas reconnection of the left inferior PV was less common (Figure). Patients treated with FP and VP had no more than two PV reconnections. In contrast, 5 patients (31.3%) treated with PS exhibited reconnection in ≥3 PVs. Notably, all cases with ≥3 PV reconnections in the PS group occurred during the early experience (first 10 cases), whereas none of the later cases (subsequent 6 cases) had ≥3 PV reconnections (reconnection in 2 PVs in 1 patient, 1 PV in 1 patient, and none in 4 patients).
Conclusions
Despite differences in catheter design and energy delivery, all three PFA systems shared a predilection for PV reconnection at the anterior right PV carina at repeat procedures. Patients treated with PS more frequently exhibited reconnection involving multiple PVs (≥3 PVs) than those treated with FP or VP; this pattern was confined to the early PS experience and may reflect a learning-curve effect. These findings highlight regions prone to reconnection and may help refine PFA application strategies to improve long-term PVI durability.TableFigure