From CHAMPION-AF to Clinical Reality: Pulmonary Vein Reconnection Patterns after Cryoballoon versus Pulsed Field Ablation

Aims: Single-shot ablation technologies, mainly cryo-balloon (CB) and pulsed field ablation (PFA), are increasingly favored for first-time pulmonary vein isolation (PVI) due to their procedural efficiency and ability to achieve rapid, safe, and durable PVI. However, comparative data on PVI durability and reconnection pattens in large real-world cohorts remain limited.

Methods: We retrospectively analyzed patients undergoing first-time PVI at a high-volume German center between 2021 and 2025. Re-mapping findings during repeat ablation after index CB-PVI were compared with those after index PFA-PVI.

Results: Among 1,961 patients (CB: n=1,369; PFA: n=592), baseline characteristics were similar between groups (age: 67 [59–74] vs. 67 [60–74] years, p=0.72; female sex: 39% vs. 36%, p=0.06; persistent AF: 53.9% vs. 54.4%, p=0.88; LVEF: 47±11% vs. 48±10%). Repeat ablation was performed in 169/1,369 (12.3%) CB patients and 35/592 (5.9%) PFA patients (p value < 0.001). Complete isolation of all PVs at repeat procedure was more frequent after PFA (45.7% vs. 22.5%, p=0.01). The mean number of reconnected PVs was higher in the CB group (1.54 ± 1.16 vs. 0.74 ± 0.82). Left-sided PV reconnection rates were comparable (LSPV: 23.1% vs. 17.1%, p=0.51; LIPV: 27.2% vs. 25.7%, p>0.99), whereas right-sided PV reconnections were significantly lower with PFA for both RSPV and RIPV (RSPV: 50.3% vs. 14.3%, p<0.001; RIPV: 48.5% vs. 14.3%, p<0.001).

Conclusion: In repeat ablation after previous CBA- or PFA-based PVI, PFA is associated with reduced reconnection rates, specifically in the right pulmonary veins compared with cryoablation.