Different techniques of repeated pulmonary vein isolation. First experiences with pulsed field ablation

Abstract Background Recurrence of atrial fibrillation after pulmonary vein isolation (PVI) reaches 20-40% rate, regardless of used modality. Until now, repeated ablations were performed using radiofrequency (RF) energy, but the emergence of new technique – pulsed field ablation (PFA) could potentially change that. Objective To compare traditionally used for repeated PVI technique: RF ablation, with new modality – PFA, in terms of procedural parameters. Methods This study is based on retrospective analysis of all consecutive repeated PVI procedures that were performed in a span of 12 months (01.10.2023 – 30.09.2024). Out of 78 ablations, 15 (19,2%) were performed using PFA modality and 1 procedure (1,3%) was a hybrid PFA-RF ablation. High-density mapping was used to identify conduction recurrence in pulmonary veins or low-voltage areas of atria that could serve as a substrate to arrhythmia. Results Repeated PVI using PFA had significantly lower procedural time compared to RF ablation (median 90 minutes vs 140 minutes; p=0.003). However, it entailed a higher dose of radiation (median 41,8 vs 14 mGy; p<0.001) and longer fluoroscopy time (median 23,7 vs 7,5 minutes; p<0.001). Procedural complications were rare. Out of all procedures, we recorded 2 cases of post-procedural stroke in the PFA group (those were minor and non-debilitating) and 1 case of arterio-venous fistula (qualified for conservative treatment by vascular surgeon) in the RF group. No periprocedural deaths were observed. Conclusions This study shows, that PFA significantly lowers procedure time and through that possibly increases the volume of treated patients. At the same time, it also increases the amount of radiation exposure of both patients and electrophysiology lab personnel.Procedure time comparison Radiation dose comparison