Long-term outcome, predictors of AF-recurrence and findings during redo-procedures after pulmonary vein isolation with Pulsed Field Ablation
A S Eberl, M Manninger, U Rohrer, L Stix, S Kurath-Koller, K Goelly, M Benedikt, E Bisping, P Lercher, A Zirlik, D ScherrAbstract
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