Background
Pulsed field ablation (PFA) is increasingly used for repeat pulmonary vein isolation (PVI) and left atrial redo procedures. However, data on the use of different PFA systems in this setting remain limited.
Methods
We retrospectively analyzed 205 consecutive redo procedures performed using focal PFA with the CENTAURI system (n=158), TactiFlex Duo (n=15), FARAPULSE (n=16), and VOLT (n=16). Baseline characteristics were comparable between groups, although patients treated with the CENTAURI system had undergone more prior ablation procedures (p=0.011). Procedural characteristics, additional ablation lines, acute procedural success, and complications were assessed.
Results
Procedural strategies differed between systems. Procedures performed with the CENTAURI system and TactiFlex Duo more frequently involved patients presenting with atrial tachycardias and flutter and were commonly combined with posterior wall isolation, roof lines, mitral lines, and cavotricuspid isthmus ablation. In contrast, procedures performed with FARAPULSE and VOLT more often consisted of repeat PVI alone.
Procedure duration differed significantly between groups (113±33 min, 91±18 min, 54±19 min, and 52±20 min for CENTAURI, TactiFlex Duo, FARAPULSE, and VOLT, respectively; p<0.01). Fluoroscopy time (9.0±5.0 min, 6.7±3.0 min, 10.6±3.1 min, and 12.3±4.8 min; p<0.01) and radiation exposure (630±419 cGy·cm², 391±148 cGy·cm², 840±591 cGy·cm², and 964±468 cGy·cm²; p<0.01) also differed significantly.
Acute procedural endpoints were achieved in all patients. Two transient right coronary artery vasospasms during cavotricuspid isthmus ablation and one conservatively managed femoral pseudoaneurysm were observed. No further major complications occurred.
Conclusion
Different PFA systems were applied to distinct redo ablation strategies in routine clinical practice, ranging from repeat PVI to complex substrate modification. Despite substantial differences in procedural complexity, acute procedural endpoints were achieved in all patients and complication rates were low across all groups. Clinical follow-up is ongoing and updated outcome data will be presented at the congress.
