Pulmonary vein reconduction is common in patients undergoing re-ablation after first-time pulsed field ablation for atrial fibrillation

Pulsed field ablation (PFA) has rapidly established itself as a standard technique for achieving pulmonary vein isolation (PVI) in the context of atrial fibrillation (AF) ablation. The recurrence rates of atrial arrythmias after PVI with PFA seem comparable to other techniques. However, studies have reported varying incidence of pulmonary vein (PV) reconduction after PFA.

Our aim was to evaluate PV reconduction during re-ablation after first-time PFA for AF.

From July 2021 – January 2024, we reviewed consecutive data from all Danish Centers performing PFA. We identified 1106 patients undergoing first time PVI with PFA technique for AF. At the index procedure, all PVs were successfully isolated with a pentaspline PFA catheter. In 47 (4%) and 61 (6%) patients a cavotricuspid isthmus block (CTIB) and posterior wall isolation was performed, respectively. All patients had a follow-up period of minimum one year (mean follow-up 747 ±227 days). All atrial tachyarrhythmiarecurrences were documented with 12-lead ECG, Holter-monitoring or smart-watch recordings. During re-ablation procedures PV reconnection sites were identified by multielectrode mapping. Fisher’s exact test was used to compare PV reconduction and a p-value <0.05 was considered statistically significant.

Of 1106 patients (63 ± 10 yrs, 709 (64%) male, BMI 27 ± 6 kg/m2, 584 (53%) paroxysmal AF), 167 (15%) patients with atrial tachyarrhytmia recurrence underwent re-ablation. The arrhythmia leading to re-ablation was AF in 126 (75%) patients, atrial flutter in 38 (23%) patients and ectopic atrial tachycardia in 3 (2%) patients. PV reconduction was reported in 108 (65%) patients while in 59 (35%) patients all PVs were isolated. The right inferior PV (RIPV) was the most common PV with reconduction (n = 75 (69%)), followed by right superior PV (RSPV n = 59 (55%)), left superior PV (LSPV n= 49 (45%)) and left inferior PV (LIPV n= 34 (31%)) (p<0.0001). In addition, 44 (40%) patients had reconduction to both RIPV and RSPV and 26 (24%) patients had reconduction in LSPV and LIPV. No patients had reconduction to all 4 PVs.

In this nationwide study, PV reconduction was found in almost 2/3 of patients undergoing re-ablation. RIPV was the most common PV with reconduction.

Pulmonary vein reconduction