ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Incidence and predictors of AF recurrence during long-term follow-up of patients after PF ablation for atrial fibrillation.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsPulsed 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. METHODS AND
resultsWe 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.
conclusionPV 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.
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