Characteristics of Recurrent Atrial Arrhythmias and Lesion Assessment Late After Pulsed Field Ablation of Atrial Fibrillation

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Abstract
BACKGROUND: Pulsed field ablation (PFA) is a novel and rapidly expanding energy for the ablation of atrial fibrillation (AF). The relationships between the characteristics of pulmonary vein (PV) and extra-PV PFA applications, and the type of arrhythmia recurrence or durable lesion observed during redo procedures remain unclear. METHODS: In this substudy of the FRANCE PFA national exhaustive multicentric registry, we collected detailed data on PFA applications delivered during the initial AF ablation procedure. Among patients with arrhythmia recurrence undergoing redo procedures with 3-dimensional mapping (n=145), we analyzed the type of recurrence, rates of durable PV isolation (PVI), and the presence of complete block over the ablation lines. RESULTS: Recurrent arrhythmias comprised AF in 58%, atrial tachycardia in 23%, and typical atrial flutter in 9%. AF was less frequently observed when initial ablation targeted extra-PV areas (45 versus 71%; P =0.01) and when a 35-mm diameter catheter was used for PVI only (50 versus 77%; P =0.01). Complete durable PVI was observed in 42% of patients (69% to 76% for each separate PV), and durable roof/PW and mitral isthmus blocks were observed in 62% and 31% of cases, respectively. The rate of durable PVI increased with the number of PFA applications ( P 12 applications. Similarly, roof/PW block rates increased to 88% with >16 applications ( P 12 PFA applications per PV and >16 for the roof/PW. Long-term durability of mitral isthmus block was poor using the Pentaspline PFA catheter.

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