Efficacy and Safety of Pulsed Field Ablation During Repeat Procedures for Treatment of Recurrent Atrial Arrhythmias After Pulmonary Vein Isolation

BACKGROUND: Little is known about the efficacy and safety of pulsed field ablation (PFA) for repeat ablation procedures for patients with recurrent atrial fibrillation (AF) after pulmonary vein (PV) isolation. OBJECTIVE: The purpose of this study was to evaluate and compare the efficacy and safety of PFA using a pentaspline ablation catheter with radiofrequency ablation (RFA) in repeat ablation procedures for atrial arrhythmia. METHODS: We compared 320 patients (mean age 71 ± 11 years, 61% male) who underwent repeat ablation procedures with PFA and RFA. Procedural data, including lesion set-specific acute success, safety endpoints, and recurrence of atrial arrhythmia were compared between groups. RESULTS: Overall, 200 and 120 patients were treated with PFA and RFA during repeat ablation, respectively. Although the rate of baseline PV reconnection was comparable between groups, PV, posterior wall, and superior vena cava ablation were targeted in significantly more patients in the PFA group compared to the RFA group. In the PFA group, PV, posterior wall, and superior vena cava isolation were successfully achieved by PFA alone in 100% cases. Adjunctive RFA was required in 31% of anterior wall and 50% of lateral mitral isthmus PFA cases to achieve line of block. Procedure times were significantly shorter in the PFA group. Major complication rates were comparable between the groups (PFA vs. RFA, 0% vs. 1.7%, p = 0.067). Freedom from atrial arrhythmia recurrence at 1 year was similar between PFA and RFA groups (59% vs. 56%; log-rank p = 0.71). CONCLUSION: Use of PFA with a pentaspline catheter for repeat AF ablation was associated with more extensive ablation compared to RFA with low complication rates but did not result in increased freedom from AF recurrence.