Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/46687
Title: Repeat procedures after pulsed field ablation for atrial fibrillation: MANIFEST-REDO study
Authors: Scherr, Daniel
Turagam, Mohit K.
Maury, Philippe
Blaauw, Yuri
van der Voort, Pepijn
Neuzil, Petr
Reichlin, Tobias
Metzner, Andreas
VIJGEN, Johan 
Kautzner, Josef
Boveda, Serge
Anic, Ante
Hansen , Jim
Manninger, Martin
Sommer, Philipp
Anselme, Frederic
Deneke, Thomas
Willems , Stephan
Tilz, Roland
Steven, Daniel
Wakili, Reza
Jais, Pierre
Funasako, Moritoshi
Arentz, Thomas
Rollin, Anne
Mulder, Bart A.
Ouss, Alexandre
Petru, Jan
Kueffer, Thomas
Lemoine, Marc D.
KOOPMAN, Pieter 
Peichl, Petr
Adelino, Raquel
Jurisic, Zrinka
Ruwald, Martin
Eberl, Anna-Sophie
Sohns, Christian
Savoure, Arnaud
Nentwich, Karin
Gunawardene, Melanie
Heeger, Christian-Hendrik
Sultan, Arian
Bohnen, Jan-Eric
Kupusovic, Jana
Derval, Nicolas
Lehrmann, Heiko
Ekanem, Emmanuel
Reddy, Vivek Y.
Issue Date: 2025
Publisher: OXFORD UNIV PRESS
Source: EP Europace, 27 (8) (Art N° euaf012)
Abstract: Aims 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 centres and involved a limited number of operators. We aimed to describe the electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF. Methods and results 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.). At 22 centres, 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% (left superior pulmonary vein), 28% (left inferior pulmonary vein), 33% (right superior pulmonary vein), and 32% (right inferior pulmonary vein). 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 >= 30 s 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 [hazard ratio 1.241 (95% confidence interval 1.534-1.005); 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.
Notes: Scherr, D (corresponding author), Med Univ Graz, Dept Internal Med, Div Cardiol, Auenbruggerpl 15, A-8036 Graz, Austria.
daniel.scherr@medunigraz.at
Keywords: Atrial fibrillation;Atrial tachycardia;Electroporation;Pulsed field ablation;Pulmonary vein isolation
Document URI: http://hdl.handle.net/1942/46687
ISSN: 1099-5129
e-ISSN: 1532-2092
DOI: 10.1093/europace/euaf012
ISI #: WOS:001550755600001
Rights: The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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