Heart rhythm · 2026
Early recurrence of atrial arrhythmias and its impact on late recurrence after pulmonary vein isolation using pulsed field ablation of paroxysmal atrial fibrillation: A long-term follow-up study.
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Lisica Lucija, Sikirić Ivan, Anić Ante, Brešković Toni, Jurišić Zrinka
Аннотация
BACKGROUND: Early recurrences of atrial arrhythmias are common after radiofrequency (RF) and cryoablation of atrial fibrillation (AF) and do not necessarily indicate treatment failure. Since tissue injury and inflammation are less extensive with pulsed field ablation (PFA), early recurrences may serve as more reliable indicators of procedure failure.
OBJECTIVE: To characterize types of atrial arrhythmias recurring after index pulmonary vein isolation using PFA (PVI-PFA) in patients with paroxysmal AF and to evaluate their occurrence rate and association with long-term clinical outcomes using implantable loop recorder (ILR).
METHODS: This single-center, prospective study enrolled consecutive patients aged >18 years undergoing single-shot PFA for symptomatic paroxysmal AF. Concomitant PVI-PFA and ILR implantation were performed to monitor AF/atrial flutter/atrial tachycardia (AF/AFL/AT) recurrence. ILR were interrogated at 1, 3, 6, and 12 months post-procedure, with subsequent follow-up visits every 6 months until the last patient concluded 1-year follow-up.
RESULTS: The median follow-up period was 24 months (interquartile range; min-max = 14-30; 12-36) months. Among 52 patients, 34 (65%) experienced AF/AFL/AT recurrence during the observation period. Early recurrence of atrial arrhythmias was observed in 20 patients (38%), all of whom experienced late recurrence as well. The overall arrhythmia burden in the entire cohort was low (0.01%), while the median arrhythmia burden among patients with recurrence was 0.3%.
CONCLUSION: Early AF/AFL/AT recurrence was a significant risk factor for late atrial arrhythmia recurrence after single-shot PVI-PFA. Although a significant portion of the participants experienced atrial arrhythmia recurrence, the overall arrhythmia burden in this subgroup remained low.
OBJECTIVE: To characterize types of atrial arrhythmias recurring after index pulmonary vein isolation using PFA (PVI-PFA) in patients with paroxysmal AF and to evaluate their occurrence rate and association with long-term clinical outcomes using implantable loop recorder (ILR).
METHODS: This single-center, prospective study enrolled consecutive patients aged >18 years undergoing single-shot PFA for symptomatic paroxysmal AF. Concomitant PVI-PFA and ILR implantation were performed to monitor AF/atrial flutter/atrial tachycardia (AF/AFL/AT) recurrence. ILR were interrogated at 1, 3, 6, and 12 months post-procedure, with subsequent follow-up visits every 6 months until the last patient concluded 1-year follow-up.
RESULTS: The median follow-up period was 24 months (interquartile range; min-max = 14-30; 12-36) months. Among 52 patients, 34 (65%) experienced AF/AFL/AT recurrence during the observation period. Early recurrence of atrial arrhythmias was observed in 20 patients (38%), all of whom experienced late recurrence as well. The overall arrhythmia burden in the entire cohort was low (0.01%), while the median arrhythmia burden among patients with recurrence was 0.3%.
CONCLUSION: Early AF/AFL/AT recurrence was a significant risk factor for late atrial arrhythmia recurrence after single-shot PVI-PFA. Although a significant portion of the participants experienced atrial arrhythmia recurrence, the overall arrhythmia burden in this subgroup remained low.