Arrhythmias & electrophysiologyCohort study
Repeat procedures after pulsed field ablation for atrial fibrillation: MANIFEST-REDO study
- Multicentre observational study of repeat ablation after pulsed field ablation
- 22 centres
Authors' 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.
Study context
- Population
- Patients undergoing repeat ablation for recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after first-ever pulmonary vein isolation (PVI) with a pentaspline pulsed field ablation (PFA) catheter (Farawave)
- Participants
- 427 patients · 22 centres
- Exposure
- PAF vs PersAF vs AT
- Outcome
- Freedom from documented AF/AT lasting ≥30 s after 3-month blanking without class I/III antiarrhythmic drugs or symptoms
- Follow-up
- Post-redo 284 (90-366) days
Main finding
As reported in the abstract
Freedom from AF/AT after repeat ablation · 284 (90-366) days
P = 0.04
- Primary effectiveness endpoint achieved, all patients
- 65%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value |
|---|---|---|
| Predictor of AT/AF recurrence after repeat ablation: persistent AF as recurrent arrhythmia | 1.241 (1.534–1.005) | P = 0.045 |
PV reconnection at repeat procedure
- Left superior PV reconnection
- 30%
- Left inferior PV reconnection
- 28%
- Right superior PV reconnection
- 33%
- Right inferior PV reconnection
- 32%
- All PVs durably isolated
- 45%
- prior use of any imaging or mapping univariately associated with durable PVI
Safety
Procedural complications
- Procedural complication rate
- 2.8%
Original publication
Repeat procedures after pulsed field ablation for atrial fibrillation: MANIFEST-REDO study. Europace. Published 17 January 2025. doi:10.1093/europace/euaf012
Summarised from the published abstract; every number is checked against it