Incidence and predictors of AF recurrence during long-term follow-up of patients after PF ablation for atrial fibrillation

Pulsed field ablation (PFA) is an established technology for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). However, data on long-term outcome remain scarce. With this work, we aim to contribute valuable long-term data on catheter ablation with PFA.

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. During the median follow-up (FUP) of 752 (391–1486) days, 34% patients (n = 116) 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 [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) was present in 16, 37, 0, and 0% after the first, second, third, and fourth procedure, respectively. In 55 analysed redo procedures, 104/221 veins (47%) were reconnected (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 success rate of 86% after ≥2 procedures.

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 86% of patients. Procedures with additional anterior lesions at the right pulmonary veins (RPVs) could be protective for recurrences.