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Multicenter Study
. 2025 Jun;36(6):1323-1332.
doi: 10.1111/jce.16670. Epub 2025 Apr 7.

Insight Into Early Recurrences After Pulsed-Field Ablation for Atrial Fibrillation: Results From a Multicenter Experience

Antonio Bisignani  1 , Francesco Solimene  2   3 , Saverio Iacopino  4 , Marco Polselli  1 , Antonio Dello Russo  2   5 , Claudio Tondo  6   7 , Antonio Rossillo  8 , Sakis Themistoclakis  9 , Ruggero Maggio  10 , Maurizio Russo  11 , Mario Volpicelli  12 , Vincenzo Schillaci  3 , Marco Schiavone  6 , Jacopo Colella  4 , Michela Casella  4   5   13 , Maurizio Malacrida  14 , Giulio Zucchelli  15 , Stefano Bianchi  1
Affiliations
Multicenter Study

Insight Into Early Recurrences After Pulsed-Field Ablation for Atrial Fibrillation: Results From a Multicenter Experience

Antonio Bisignani et al. J Cardiovasc Electrophysiol. 2025 Jun.

Abstract

Background: Factors contributing to early recurrence after atrial fibrillation (AF) ablation, particularly with pulsed-field ablation (PFA), are poorly understood.

Purpose: This study aimed to evaluate the significance of early recurrence and identify factors associated with its occurrence, focusing on predicting late recurrence in AF patients treated with PFA.

Methods: A total of 620 consecutive patients referred for their first paroxysmal or early persistent AF ablation underwent the procedure using the FARAPULSE PFA system (Boston Scientific) across 10 centers. Early recurrence was defined as atrial arrhythmia of > 30-s duration during the 3-month blanking period, and any recurrence beyond 3 months was considered as late recurrence.

Results: In total, 44 (7.1%) patients experienced early recurrences (median time to recurrence: 56 [22-75] days). At multivariate logistic analysis adjusted for baseline confounders larger left atrial volume index (LAVi) (1.03, 1.01-1.06, p = 0.0034) was significantly associated with early recurrences. In total, 113 (18.2%) patients experienced late recurrences. Factors independently associated with late recurrences included age (1.03, 1.01-1.05, p = 0.0077), sleep apnea (3.17, 1.73-5.81, p = 0.002), and early recurrences (3.26, 2.01-5.29, p < 0.0001). Early recurrences were associated to late recurrences also in paroxysmal AF only patients (40.0% vs. 16.9%, p < 0.0001).

Conclusion: In this cohort of AF patients undergoing PFA, early recurrences significantly increased the risk of late recurrences, highlighting their potential as a predictive marker for long-term outcomes. Moreover, larger LAVi was associated with early recurrences.

Trial registration: Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/. Identifier: NCT05617456.

Keywords: AF; atrial fibrillation; early recurrences; electroporation; pulsed‐field ablation.

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References

    1. I. C. Van Gelder, M. Rienstra, K. V. Bunting, et al., “2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio‐Thoracic Surgery (EACTS),” European Heart Journal 45, no. 36 (September 2024): 3314–3414.
    1. H. Calkins, G. Hindricks, R. Cappato, et al., “2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Executive Summary,” Europace 20 (2018): 157–208.
    1. S. Tzeis, E. P. Gerstenfeld, J. Kalman, et al., “2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation,” Europace 26, no. 4 (March 2024): euae043.
    1. M. Grimaldi, A. Di Monaco, T. Gomez, et al., “Time Course of Irreversible Electroporation Lesion Development Through Short‐ and Long‐Term Follow‐Up in Pulsed‐Field Ablation‐Treated Hearts,” Circulation: Arrhythmia and Electrophysiology 15, no. 7 (July 2022): e010661.
    1. P. Osmancik, B. Bacova, M. Hozman, et al., “Myocardial Damage, Inflammation, Coagulation, and Platelet Activity During Catheter Ablation Using Radiofrequency and Pulsed‐Field Energy,” JACC: Clinical Electrophysiology 10, no. 3 (March 2024): 463–474, https://doi.org/10.1016/j.jacep.2023.11.001.

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