Temporal patterns of atrial fibrillation recurrence after catheter ablation using pulsed-field ablation

Abstract Background The prognostic implications of temporal patterns of atrial fibrillation (AF) recurrence after catheter ablation might differ between thermal and non-thermal energy sources such as pulsed-field ablation (PFA). While recurrence of AF during the blanking period after thermal ablation is typically not considered as a predictor for late recurrence, the impact of early recurrence of AF after PFA ablation is incompletely understood. Objective To assess the impact of early recurrence within the first 3 months as a potential risk factor for late recurrence in AF patients undergoing pulmonary vein isolation (PVI) using PFA. Methods Consecutive patients undergoing PVI PFA were enrolled and prospectively followed up for at least 365 days. Early recurrence was defined as atrial arrhythmia lasting more than 30 seconds during a 90-day blanking period, while any recurrence occurring after 90 days was classified as late recurrence. Results A total of 233 patients who underwent PFA for AF and had complete 365 days follow-up data available were included. The overall arrhythmia-free survival at 365 days was 72% (167 of 233 patients). Early recurrence was observed overall in 43 patients (19%). Of these, 49%, 21% and 30% were first observed within the 1st, 2nd and 3rd month after the ablation procedure. Among patients with recurrence within the 1st month, 2nd and 3rd month, no late recurrence was observed in 48%, 33% and 31% of patients, respectively, p<0.001. Among patients with early recurrence undergoing redo procedures (n=82, 35%), the rate of durably isolated PV was 29%, 33% and 23% for early recurrence in the 1st, 2nd and 3rd month, p = 0.211, respectively (Figure1). Conclusion In this consecutive series of AF patients, early recurrence, especially during the 2nd or 3rd month after PVI, was strongly associated with an increased risk of late recurrence. While half of the early recurrences in the 1st month resolved, only a third of early recurrences in the 2nd and 3rd month resolved during 365 days of follow-up. The rate of durably isolated PV was similar among patients with early recurrence in the 1st, 2nd or 3rd month.Graphical Abstract Figure1