TY - JOUR
T1 - Repeat Procedures After Pulsed Field Ablation for Atrial Fibrillation
T2 - MANIFEST-REDO Study
AU - Scherr, Daniel
AU - Turagam, Mohit K
AU - Maury, Philippe
AU - Blaauw, Yuri
AU - van der Voort, Pepijn
AU - Neuzil, Petr
AU - Reichlin, Tobias
AU - Metzner, Andreas
AU - Vijgen, Johan
AU - Kautzner, Josef
AU - Boveda, Serge
AU - Anic, Ante
AU - Hansen, Jim
AU - Manninger, Martin
AU - Sommer, Philipp
AU - Anselme, Frederic
AU - Willems, Stephan
AU - Deneke, Thomas
AU - Tilz, Roland
AU - Steven, Daniel
AU - Wakili, Reza
AU - Jais, Pierre
AU - Funasako, Moritoshi
AU - Arentz, Thomas
AU - Rollin, Anne
AU - Mulder, Bart A
AU - Ouss, Alexandre
AU - Petru, Jan
AU - Kueffer, Thomas
AU - Lemoine, Marc D
AU - Koopman, Pieter
AU - Peichl, Petr
AU - Adelino, Raquel
AU - Jurisic, Zrinka
AU - Ruwald, Martin
AU - Eberl, Anna-Sophie
AU - Sohns, Christian
AU - Savoure, Arnaud
AU - Nentwich, Karin
AU - Gunawardene, Melanie
AU - Heeger, Christian-Hendrik
AU - Sultan, Arian
AU - Bohnen, Jan-Eric
AU - Kupusovic, Jana
AU - Derval, Nicolas
AU - Lehrmann, Heiko
AU - Ekanem, Emmanuel
AU - Reddy, Vivek Y
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2025/1/17
Y1 - 2025/1/17
N2 - BACKGROUND: Initial clinical studies of pulsed field ablation (PFA) to treat atrial fibrillation (AF) indicated a >90% durability rate of pulmonary vein isolation (PVI). However, these studies were largely conducted in single centers and involved a limited number of operators. The electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF are incompletely understood.METHODS: In the MANIFEST-REDO study, we investigated patients who underwent repeat ablation due to clinical recurrence - AF or atrial tachycardia (AT) - following first-ever PVI with a pentaspline PFA catheter (Farawave; Boston Scientific Inc).RESULTS: At 22 centers, 427 patients (age 64±11 years; 37% female) were included. Of note, the recurrent arrhythmia leading to the repeat ablation was paroxysmal AF (51%), persistent AF (30%), or AT (19%). At the repeat procedure, the PV reconnection rates were: 30% (LSPV), 28% (LIPV), 33% (RSPV) and 32% (RIPV). In 45% of patients all PVs were durably isolated at the beginning of the repeat procedure, with the previous use of any imaging or mapping modality being univariately associated with durable PVI. After a post-redo follow-up period of 284 [90-366] days, the primary effectiveness endpoint (freedom from documented AF/AT lasting ≥30s after 3-month blanking without class I/III antiarrhythmic drugs or symptoms) was achieved in 65% of patients, with significant differences between groups (PAF 65% vs. PersAF 56% vs. AT 76%; p=0.04). Persistent AF as recurrent arrhythmia after the initial PFA ablation predicted AT/AF recurrence after repeat ablation (HR 1.241 (95% CI 1.534-1.005 CI); p=0.045). The procedural complication rate was 2.8%.CONCLUSION: In repeat procedures for AF/AT performed after an index procedure with PFA for AF, PV reconnections are not uncommon. Repeat procedures can be performed safely and with an acceptable subsequent success rate.
AB - BACKGROUND: Initial clinical studies of pulsed field ablation (PFA) to treat atrial fibrillation (AF) indicated a >90% durability rate of pulmonary vein isolation (PVI). However, these studies were largely conducted in single centers and involved a limited number of operators. The electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF are incompletely understood.METHODS: In the MANIFEST-REDO study, we investigated patients who underwent repeat ablation due to clinical recurrence - AF or atrial tachycardia (AT) - following first-ever PVI with a pentaspline PFA catheter (Farawave; Boston Scientific Inc).RESULTS: At 22 centers, 427 patients (age 64±11 years; 37% female) were included. Of note, the recurrent arrhythmia leading to the repeat ablation was paroxysmal AF (51%), persistent AF (30%), or AT (19%). At the repeat procedure, the PV reconnection rates were: 30% (LSPV), 28% (LIPV), 33% (RSPV) and 32% (RIPV). In 45% of patients all PVs were durably isolated at the beginning of the repeat procedure, with the previous use of any imaging or mapping modality being univariately associated with durable PVI. After a post-redo follow-up period of 284 [90-366] days, the primary effectiveness endpoint (freedom from documented AF/AT lasting ≥30s after 3-month blanking without class I/III antiarrhythmic drugs or symptoms) was achieved in 65% of patients, with significant differences between groups (PAF 65% vs. PersAF 56% vs. AT 76%; p=0.04). Persistent AF as recurrent arrhythmia after the initial PFA ablation predicted AT/AF recurrence after repeat ablation (HR 1.241 (95% CI 1.534-1.005 CI); p=0.045). The procedural complication rate was 2.8%.CONCLUSION: In repeat procedures for AF/AT performed after an index procedure with PFA for AF, PV reconnections are not uncommon. Repeat procedures can be performed safely and with an acceptable subsequent success rate.
U2 - 10.1093/europace/euaf012
DO - 10.1093/europace/euaf012
M3 - Article
C2 - 39824172
SN - 1099-5129
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
M1 - euaf012
ER -