Weyand Sebastian, Adam Viola, Biehler Paloma, Hägele Patricia, Hanger Simon, Löbig Stephanie, Pinchuk Andrei, Ausbuettel Felix, Waechter Christian, Seizer Peter
Medizinische Klinik II - Kardiologie und Angiologie, Ostalb-Klinikum Aalen, Im Kälblesrain 1, 73430, Aalen, Germany.
Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Baldingerstraße, 35043, Marburg, Germany.
J Interv Card Electrophysiol. 2025 May 28. doi: 10.1007/s10840-025-02079-8.
Redo ablation procedures are frequently required in patients with recurrent atrial fibrillation (AF) and atypical atrial flutter following initial pulmonary vein isolation (PVI). While focal pulsed-field ablation (PFA) has emerged as a promising nonthermal alternative, data on its long-term efficacy and safety in redo procedures remain limited. This study evaluates the 1-year outcomes of focal PFA in redo ablations for AF and atypical flutter, focusing on arrhythmia recurrence, procedural success, and safety.
A retrospective analysis was conducted on 54 patients undergoing redo ablation with focal PFA at a single center. Procedural endpoints included acute and chronic procedural success, additional ablation line integrity, and complication rates. Arrhythmia recurrence was assessed via ECG and 24-h Holter monitoring at 6 and 12 months.
Complete PVI and bidirectional block of all additional ablation lines were confirmed in all cases at the end of the procedure. During the 1-year follow-up, 29.63% of patients experienced arrhythmia recurrence. Among patients undergoing a further redo ablation, reconnections were most frequently observed in the anterior mitral line, suggesting challenges in lesion durability in this region. The overall complication rate was low (1.85%), with one case of coronary vasospasm during cavotricuspid isthmus ablation.
Focal PFA appears to be a feasible and safe option for redo ablations in AF and atypical flutter, with high acute success rates and acceptable arrhythmia control at 1 year. However, lesion durability, especially for complex lines, remains a limitation, underscoring the need for optimization and further prospective evaluation against thermal ablation.
对于初次肺静脉隔离（PVI）后复发心房颤动（AF）和非典型心房扑动的患者，经常需要进行再次消融手术。虽然局灶性脉冲场消融（PFA）已成为一种有前景的非热替代方法，但其在再次消融手术中的长期疗效和安全性数据仍然有限。本研究评估了局灶性PFA在AF和非典型扑动再次消融中的1年结局，重点关注心律失常复发、手术成功率和安全性。
对在单一中心接受局灶性PFA再次消融的54例患者进行回顾性分析。手术终点包括急性和慢性手术成功率、额外消融线的完整性以及并发症发生率。通过心电图和6个月及12个月时的24小时动态心电图监测评估心律失常复发情况。
在手术结束时，所有病例均确认完成了PVI且所有额外消融线均实现双向阻滞。在1年的随访期间，29.63%的患者出现心律失常复发。在接受进一步再次消融的患者中，二尖瓣前叶线最常出现重新连接，提示该区域病变持久性存在挑战。总体并发症发生率较低（1.85%），在三尖瓣峡部消融期间有1例冠状动脉痉挛。
局灶性PFA似乎是AF和非典型扑动再次消融的一种可行且安全的选择，急性成功率高，1年时心律失常控制情况可接受。然而，病变持久性，尤其是复杂线路的病变持久性，仍然是一个限制因素，这突出了优化以及与热消融进行进一步前瞻性评估的必要性。
