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Multicenter Study
. 2025 Sep;68(6):1267-1281.
doi: 10.1007/s10840-025-02021-y. Epub 2025 Mar 4.

Redo ablation procedures to treat recurrent atrial arrhythmias via a pentaspline pulsed field ablation catheter: a prospective, multicenter experience

María Cespón-Fernández  1 , Domenico G Della Rocca  2   3   4 , Michele Magnocavallo  5 , Andrés Betancur  6 , Ilenia Lombardo  1 , Luigi Pannone  1 , Giampaolo Vetta  1 , Antonio Sorgente  1 , Marco Polselli  5 , Charles Audiat  1 , Alvise Del Monte  1 , Stéphane Combes  6 , Lorenzo Marcon  1 , Ingrid Overeinder  1 , Kazutaka Nakasone  1 , Sahar Mouram  1 , Sanghamitra Mohanty  7 , Stefano Bianchi  5 , Alexandre Almorad  1 , Juan Sieira  1 , Gezim Bala  1 , Erwin Ströker  1 , Pietro Rossi  5 , Andrea Sarkozy  1 , Serge Boveda  6 , Andrea Natale  7 , Carlo de Asmundis  1 , Gian-Battista Chierchia  1 ; HRMC Investigators
Collaborators, Affiliations
Multicenter Study

Redo ablation procedures to treat recurrent atrial arrhythmias via a pentaspline pulsed field ablation catheter: a prospective, multicenter experience

María Cespón-Fernández et al. J Interv Card Electrophysiol. 2025 Sep.

Abstract

Background: Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.

Methods: Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations.

Results: A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12 months was 78.3% (95% CI 69.6-84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; p = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times.

Conclusion: The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. No clinical differences were observed between PFA and RF; however, redo PFA cases were significantly shorter.

Keywords: Atrial fibrillation, Posterior wall; Atrio-esophageal fistula; Pulsed field ablation; Redo ablation; Tissue selectivity.

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Conflict of interest statement

Declarations. Competing interests: AN received speaker honoraria from Boston-Scientific, Biosense-Webster, Abbott, and Medtronic and is a consultant for Biosense-Webster and Janssen. AS is consultant for Biosense-Webster and received teaching compensation from Medtronic. GBC received teaching compensation from Abbott and Boston-Scientific. CdA received research grants from Medtronic, Abbott, and Boston-Scientific and teaching compensation from Boston-Scientific and Atricure.

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