EP – EuropaceRepeat Procedures After Pulsed Field Ablation for Atrial Fibrillation: MANIFEST-REDO Study

The MANIFEST-REDO study examined outcomes in patients requiring repeat ablation after initial pulsed field ablation (PFA) for atrial fibrillation. This multicenter investigation of 427 patients provides key insights into pulmonary vein reconnection rates and procedural success rates following PFA, addressing an important knowledge gap in the durability of this emerging technology.

Study Design:

• Multicenter study conducted across 22 centers
• 427 patients (mean age 64±11 years, 37% female)
• All patients underwent initial PVI using pentaspline PFA catheter (Farawave; Boston Scientific)
• Follow-up period after redo procedure: 284 [90-366] days
• Primary effectiveness endpoint: freedom from documented AF/AT ≥30s after 3-month blanking without class I/III antiarrhythmic drugs or symptoms

Key Findings:

• Recurrent arrhythmia distribution: paroxysmal AF (51%), persistent AF (30%), AT (19%)
• PV reconnection rates by location: LSPV (30%), LIPV (28%), RSPV (33%), RIPV (32%)
• 45% of patients maintained complete PV isolation from initial procedure
• Primary effectiveness endpoint achieved in 65% of patients overall
• Success rates varied by arrhythmia type: PAF 65%, PersAF 56%, AT 76% (p=0.04)
• Persistent AF predicted AT/AF recurrence after repeat ablation (HR 1.241, 95% CI 1.534-1.005)
• Procedural complication rate: 2.8%

HCN Medical Memo
Although PFA demonstrates promising durability in many cases, physicians should consider arrhythmia type when counseling patients about potential need for repeat procedures. The higher success rates in AT versus persistent AF suggest careful patient selection may optimize outcomes.

Afib Summaries