Repeat procedures after pulsed field ablation for atrial fibrillation: MANIFEST-REDO study

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Technology

Background:

• Initial pulsed field ablation (PFA) studies for atrial fibrillation (AF) reported high pulmonary vein isolation (PVI) durability.
• Limited data exists on repeat ablation outcomes after index PFA, especially regarding electrophysiological findings.

Purpose of the Study:

• To investigate outcomes of repeat ablation procedures in patients experiencing recurrence after initial PFA for AF.
• To assess pulmonary vein (PV) reconnection rates and clinical effectiveness following repeat PFA.

Main Methods:

• The MANIFEST-REDO study included 427 patients undergoing repeat ablation for AF/atrial tachycardia (AT) after first-ever PVI with a PFA catheter.
• PV reconnection rates and clinical success (freedom from AF/AT) were evaluated after a median follow-up of 284 days.

Main Results:

• Pulmonary vein reconnections were observed in 28-33% of PVs during repeat procedures.
• The overall success rate for freedom from AF/AT was 65%, with variations based on initial diagnosis (paroxysmal AF, persistent AF, AT).
• Repeat PFA procedures demonstrated a 2.8% complication rate.

Conclusions:

• Pulmonary vein reconnections are frequent in repeat ablation procedures following index PFA for AF.
• Repeat PFA procedures are safe and offer an acceptable success rate for managing recurrent AF/AT.