Scherr Daniel, Turagam Mohit K, Maury Philippe, Blaauw Yuri, van der Voort Pepijn, Neuzil Petr, Reichlin Tobias, Metzner Andreas, Vijgen Johan, Kautzner Josef, Boveda Serge, Anic Ante, Hansen Jim, Manninger Martin, Sommer Philipp, Anselme Frederic, Willems Stephan, Deneke Thomas, Tilz Roland, Steven Daniel, Wakili Reza, Jais Pierre, Funasako Moritoshi, Arentz Thomas, Rollin Anne, Mulder Bart A, Ouss Alexandre, Petru Jan, Kueffer Thomas, Lemoine Marc D, Koopman Pieter, Peichl Petr, Adelino Raquel, Jurisic Zrinka, Ruwald Martin, Eberl Anna-Sophie, Sohns Christian, Savoure Arnaud, Nentwich Karin, Gunawardene Melanie, Heeger Christian-Hendrik, Sultan Arian, Bohnen Jan-Eric, Kupusovic Jana, Derval Nicolas, Lehrmann Heiko, Ekanem Emmanuel, Reddy Vivek Y
Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Europace. 2025 Aug 4;27(8). doi: 10.1093/europace/euaf012.
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 centres and involved a limited number of operators. We aimed to describe the electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF.
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.). At 22 centres, 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% (left superior pulmonary vein), 28% (left inferior pulmonary vein), 33% (right superior pulmonary vein), and 32% (right inferior pulmonary vein). 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 ≥30 s 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 [hazard ratio 1.241 (95% confidence interval 1.534-1.005); P = 0.045]. The procedural complication rate was 2.8%.
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.
脉冲场消融（PFA）治疗心房颤动（AF）的初步临床研究表明，肺静脉隔离（PVI）的持久率>90%。然而，这些研究大多在单一中心进行，且涉及的操作者数量有限。我们旨在描述首次PFA消融治疗AF后接受再次消融患者的电生理检查结果和预后情况。
在MANIFEST-REDO研究中，我们调查了因首次使用五棱形PFA导管（Farawave，波士顿科学公司）进行PVI后出现临床复发的AF或房性心动过速（AT）而接受再次消融的患者。在22个中心，纳入了427例患者（年龄64±11岁；37%为女性）。值得注意的是，导致再次消融的复发性心律失常为阵发性AF（51%）、持续性AF（30%）或AT（19%）。在再次手术时，肺静脉重新连接率分别为：左上肺静脉30%、左下肺静脉28%、右上肺静脉33%、右下肺静脉32%。45%的患者在再次手术开始时所有肺静脉均实现了持久隔离，既往使用任何成像或标测方式均与持久的PVI单因素相关。在再次手术后284（90 - 366）天的随访期后，65%的患者达到了主要有效性终点（在3个月空白期且未使用I类/III类抗心律失常药物或无相关症状的情况下，无持续≥30秒的记录在案的AF/AT），各亚组之间存在显著差异（阵发性AF为65%，持续性AF为56%，AT为76%；P = 0.04）。首次PFA消融后复发性心律失常为持续性AF可预测再次消融后AT/AF复发[风险比1.241（95%置信区间1.534 - 1.005）；P = 0.045]。手术并发症发生率为2.8%。
在首次使用PFA治疗AF后进行的AF/AT再次手术中，肺静脉重新连接并不少见。再次手术可以安全进行，且后续成功率可接受。
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