Are there pulmonary vein geometrical features associated with reconnection after pulsed field ablation of atrial fibrillation?

Background: Pulmonary vein (PV) isolation (PVI) using pulsed field ablation (PFA) is an emerging technique for the treatment of atrial fibrillation (AF). However, the recurrence rate of AF remains significant, and the durability of PVI is insufficient.

Objective: This study aimed to assess the impact of anatomical and geometrical features of the PV ostia on the PVI durability.

Methods: In this multicenter study focusing on AF patients treated with PFA using the pentaspline catheter, pre-ablation computed tomography images were used to measure the anatomical and geometrical characteristics of each PV ostium. All patients experienced arrhythmia recurrence and underwent a second procedure with high-resolution mapping of the left atrium, allowing the assessment of reconnection for each PV.

Results: Overall, 99 patients (median age 65 years, 69% males), corresponding to 398 PVs, were included. Up to 69% of patients had at least 1 reconnected PV, and the PV reconnection rate ranged from 30% to 37%, with no significant difference between PVs. A larger long-axis diameter (adjusted odds ratio [aOR] 1.06 per 1 mm increase, 95% confidence interval [CI] 1.00-1.12; P = .04) and a larger difference in lateral angulation between ipsilateral PVs (aOR 1.02 per 1 mm increase, 95% CI 1.00-1.03; P < .01) were associated with PV reconnection. The area under the receiver operator characteristic curve was <0.70 for both these parameters.

Conclusion: The impact of the anatomical characteristics of PVs on PV reconnection was limited, confirming the ability of the PFA pentaspline catheter to adapt to various PV anatomies.