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. 2025 Nov;68(8):1625-1636.
doi: 10.1007/s10840-025-02079-8. Epub 2025 May 28.

One-year outcomes of focal pulsed-field ablation for redo procedures in atrial fibrillation and atypical flutter

Sebastian Weyand  1 , Viola Adam  2 , Paloma Biehler  2 , Patricia Hägele  2 , Simon Hanger  2 , Stephanie Löbig  2 , Andrei Pinchuk  2 , Felix Ausbuettel  3 , Christian Waechter  3 , Peter Seizer  4   5
Affiliations

One-year outcomes of focal pulsed-field ablation for redo procedures in atrial fibrillation and atypical flutter

Sebastian Weyand et al. J Interv Card Electrophysiol. 2025 Nov.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Atrial fibrillation; Catheter ablation; Focal pulsed-field ablation; Left atrial arrythmia; Repeat ablation.

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Conflict of interest statement

Declarations. Institutional review board: The study was performed in compliance with the principles outlined in the Declaration of Helsinki and approved by the ethics committee of the Landesärztekammer Baden-Württemberg (reg. no. F-2021–077). Consent to participate: Patient consent was waived due to the retrospective character of this study in accordance with the local ethics committee. Competing interests: The authors declare that they have no competing interests.

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