Pulmonary Vein Reconnection Characteristics After Index Pulsed Field vs Radiofrequency Ablation for Atrial Fibrillation.

BACKGROUND

Patients undergoing repeat procedures for atrial fibrillation (AF) recurrence may have undergone an index procedure with pulsed field ablation (PFA) or radiofrequency ablation (RFA). Whether differences exist in the anatomical distribution and extent of pulmonary vein (PV) reconnection has not been described.

OBJECTIVES

This study sought to compare the distribution and extent of PV reconnection in patients undergoing redo AF ablation after index PFA vs RFA rather than the durability of pulmonary vein isolation (PVI) between ablation technologies.

METHODS

In this retrospective multicenter observational study, consecutive patients undergoing high-density multipolar mapping and RFA for recurrent AF with PV reconnection following index RFA or PFA were enrolled between March 2024 and October 2025.

RESULTS

A total of 103 patients (mean age 65 ± 10 years, paroxysmal AF in 67%, 34% female) underwent redo ablation following index PVI, with RFA in 53 and PFA in 50. The number of PVs reconnected was higher post-index PFA than RFA (2.7 ± 1 vs 2.0 ± 0.8 RFA; P < 0.001). Reconnection of the left PVs was more frequent post-PFA (86% vs 49% RFA; P < 0.01), with no difference for right PVs (74% vs 75% RFA; P = 1.0). The extent of PV reconnection was greater post-PFA (87 mm [Q1-Q3: 56-121 mm] vs 19 mm [Q1-Q3: 12-38 mm] post-RFA; P < 0.001). PV reconnection was more common anteriorly post-PFA vs posterior and carinal post-RFA.

CONCLUSIONS

In patients undergoing repeat ablation for recurrent AF, reconnection more commonly involved the left PVs, was more extensive, and required significantly more ablation following index pentaspline PFA compared with index point-by-point RFA. No direct comparison of PVI durability can be made between PFA and RFA based on these results.