Early recurrences predict late therapy failure after pulsed field ablation of atrial fibrillation

Abstract Introduction Pulsed field ablation (PFA) is a new ablation technology for atrial fibrillation (AF). Data regarding early recurrences of atrial tachyarrhythmia (ERAT) after PFA‐pulmonary vein isolation (PVI) are sparse. Methods Consecutive patients with symptomatic AF were enrolled to undergo PFA‐PVI. A dedicated catheter delivering bipolar energy (1.9–2.0 kV) was used. Late recurrence (LR) was defined as documented AF/atrial tachycardia (AT) lasting more than 30 s after a 90‐day blanking period. Results Two hundred and thirty‐one patients (42% female, age 69 ± 12, 55% paroxysmal AF [PAF]) were included in this analysis. Median follow‐up time was 367 days (interquartile range: 253–400). Forty‐six patients (21%) experienced ERAT after a median of 23 days (46% in PAF and 54% in persistent AF [persAF]). Kaplan–Meier estimated freedom of AF/AT was 74.2% at 1 year, 81.8% for PAF, and 64.8% for persAF ( p = .0079). Of patients experiencing ERAT, an LR was observed in 54%. There was no significant difference of LR between those who presented with very early ERAT (0–45 days) and those with ERAT (46–90 days) ( p = .57). In multivariate analysis, ERAT (hazard ratio [HR]: 3.370; 95% confidence interval [95% CI]: 1.851–6.136; p < .001) and female sex (HR: 2.048; 95% CI: 1.114–3.768; p = .021) were the only independent predictors for LR. Conclusions ERAT could be recorded in 21% of patients after PFA‐PVI and was an independent predictor for LR. We found no difference in the rate of LRs among patients experiencing ERAT before or after 45 days.