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Background <p>Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.</p> Methods <p>Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations.</p> Results <p>A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12&#xa0;months was 78.3% (95% CI 69.6–84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; <i>p</i> = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times.</p> Conclusion <p>The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. No clinical differences were observed between PFA and RF; however, redo PFA cases were significantly shorter.</p> Graphical Abstract <p></p>

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Redo ablation procedures to treat recurrent atrial arrhythmias via a pentaspline pulsed field ablation catheter: a prospective, multicenter experience

  • 期刊论文

  • 发表日期：

    2025年3月4日

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  • María Cespón-Fernández,
  • Domenico G. Della Rocca,
  • Michele Magnocavallo,
  • Andrés Betancur,
  • Ilenia Lombardo,
  • Luigi Pannone,
  • Giampaolo Vetta,
  • Antonio Sorgente,
  • Marco Polselli,
  • Charles Audiat,
  • Alvise del Monte,
  • Stéphane Combes,
  • Lorenzo Marcon,
  • Ingrid Overeinder,
  • Kazutaka Nakasone,
  • Sahar Mouram,
  • Sanghamitra Mohanty,
  • Stefano Bianchi,
  • Alexandre Almorad,
  • Juan Sieira,
  • Gezim Bala,
  • Erwin Ströker,
  • Pietro Rossi,
  • Andrea Sarkozy,
  • Serge Boveda,
  • Andrea Natale,
  • Carlo de Asmundis,
  • Gian-Battista Chierchia,
  • Ioannis Doundoulakis,
  • Cinzia Monaco,
  • Ivan Eltsov,
  • Roberto Scacciavillani

摘要

Background

Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.

Methods

Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations.

Results

A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12 months was 78.3% (95% CI 69.6–84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; p = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times.

Conclusion

The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. No clinical differences were observed between PFA and RF; however, redo PFA cases were significantly shorter.

Graphical Abstract