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SHR Neuro Cancer Cardio Lipid Metab Microb
Scherr, D; Turagam, MK; Maury, P; Blaauw, Y; van, der, Voort, P; Neuzil, P; Reichlin, T; Metzner, A; Vijgen, J; Kautzner, J; Boveda, S; Anic, A; Hansen, J; Manninger, M; Sommer, P; Anselme, F; Willems, S; Deneke, T; Tilz, R; Steven, D; Wakili, R; Jais, P; Funasako, M; Arentz, T; Rollin, A; Mulder, BA; Ouss, A; Petru, J; Kueffer, T; Lemoine, MD; Koopman, P; Peichl, P; Adelino, R; Jurisic, Z; Ruwald, M; Eberl, AS; Sohns, C; Savoure, A; Nentwich, K; Gunawardene, M; Heeger, CH; Sultan, A; Bohnen, JE; Kupusovic, J; Derval, N; Lehrmann, H; Ekanem, E; Reddy, VY.
Repeat Procedures After Pulsed Field Ablation for Atrial Fibrillation: MANIFEST-REDO Study.
Europace. 2025;
Doi: 10.1093/europace/euaf012
PubMed
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- Leading authors Med Uni Graz
- Scherr Daniel
- Co-authors Med Uni Graz
- Eberl Anna-Sophie
- Manninger-Wünscher Martin
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- Abstract:
- BACKGROUND: Initial clinical studies of pulsed field ablation (PFA) to treat atrial fibrillation (AF) indicated a >90% durability rate of pulmonary vein isolation (PVI). However, these studies were largely conducted in single centers and involved a limited number of operators. The electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF are incompletely understood. METHODS: In the MANIFEST-REDO study, we investigated patients who underwent repeat ablation due to clinical recurrence - AF or atrial tachycardia (AT) - following first-ever PVI with a pentaspline PFA catheter (Farawave; Boston Scientific Inc). RESULTS: At 22 centers, 427 patients (age 64±11 years; 37% female) were included. Of note, the recurrent arrhythmia leading to the repeat ablation was paroxysmal AF (51%), persistent AF (30%), or AT (19%). At the repeat procedure, the PV reconnection rates were: 30% (LSPV), 28% (LIPV), 33% (RSPV) and 32% (RIPV). In 45% of patients all PVs were durably isolated at the beginning of the repeat procedure, with the previous use of any imaging or mapping modality being univariately associated with durable PVI. After a post-redo follow-up period of 284 [90-366] days, the primary effectiveness endpoint (freedom from documented AF/AT lasting ≥30s after 3-month blanking without class I/III antiarrhythmic drugs or symptoms) was achieved in 65% of patients, with significant differences between groups (PAF 65% vs. PersAF 56% vs. AT 76%; p=0.04). Persistent AF as recurrent arrhythmia after the initial PFA ablation predicted AT/AF recurrence after repeat ablation (HR 1.241 (95% CI 1.534-1.005 CI); p=0.045). The procedural complication rate was 2.8%. CONCLUSION: In repeat procedures for AF/AT performed after an index procedure with PFA for AF, PV reconnections are not uncommon. Repeat procedures can be performed safely and with an acceptable subsequent success rate.