Pattern of reconnection after isolation of the pulmonary veins with a pulsed-field ablation

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Abstract Background Pulsed Field Ablation (PFA) has proven is efficacy for pulmonary vein isolation (PVI) with an acute success in 99.9% of PVI and few major complications (1.6% of patients). (1) However, in redo procedures, the durability of the PVI was 63% at a median of 6 month in a study of Kueffer and al. (2) Purpose The purpose of this study is to analyze the pattern of these reconnections in the redo procedures. Methods We retrospectively analyzed the data among the patients that had a PVI with PFA in our institution between 1 October 2022 and 1 October 2023 who were referred for a recurrence of a tachyarrhythmia. Results Of 350 patients treated for PVI with PFA, 14 patients (4%) were referred for a recurrence of tachyarrhythmia. Among them, three (21%) were female and the median age was 72 years old [IQR 69-78]. The Chadvasc score was > 2 in 7 (50%) patients and the DR flash score was > 3 also in 7 (50%) patients. The patients were referred for paroxysmal AF (4/14 patients), persistent AF (5/14 patients), typical flutter (2/14 patients) or atypical flutter (3/14 patients). All patients had a high resolution 3D electro-anatomical mapping, in a median time of 7,4 months [IQR 5,1-11,8]. The median left atrium volume was 169 mL [IQR 150-180] and 66% of the pulmonary veins were isolated. Only two patients (14%) had durable PVI in all their veins. Two of the patients had a posterior box with their PVI and the box was blocked at 7 and 13 months after the PFA. The reconnections of the pulmonary veins was mainly in the anterior aspect of the right superior PV (6/19 reconnections, 32%). There were two typical shapes of reconnection, the « missing petal » and the « collar » patterns. Conclusion In a redo procedures at 7 months after a PFA, 14% of the patients had durable PVI and 66% of the veins were isolated. The reconnections were mainly in the anterior right superior PV and had often a typical « missing petal » or « collar» patterns.Percentage ReconnectionsPatterns Reconnections