Background:Patients with nonischemic cardiomyopathy (NICM) are at risk for sustained ventricular tachycardia (VT). Implantable cardioverter-defibrillators (ICDs) are guideline-recommended for secondary prevention, but the necessity of routine ICD implantation after successful catheter ablation (CA) in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF > 35%) remains uncertain. This review summarizes the current evidence. Methods:A PROSPERO-registered systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Cochrane were searched through June 2025. Studies including adults with NICM and LVEF > 35% undergoing CA for sustained monomorphic VT were eligible. Data on patient characteristics, ablation outcomes, VT recurrence, mortality, and ICD therapies were extracted. Results were descriptively synthesized, and weighted means were calculated when feasible. Results:Eleven studies (1995-2024), including 1430 patients, were identified; 936 (66%) were analyzable. The weighted mean LVEF was 38% ± 14%; mean age was 59 ± 14 years. Sustained VT recurrence ranged from 14%-67% during a weighted mean follow-up period of 608 ± 745 days. Procedural noninducibility consistently predicted lower recurrence rates (18%-32%), than those in inducible patients (up to 75%). Two studies using cardiac magnetic resonance imaging found non-circumferential mid-myocardial late gadolinium enhancement with septal involvement associated with higher recurrence risk. Risk of bias was moderate to serious. Conclusions:In NICM patients with LVEF > 35%, noninducibility after CA predicts favourable arrhythmic outcomes. Non-circumferential mid-myocardial late gadolinium enhancement with septal involvement, and inducibility after VT ablation, identify higher-risk patients. Registration:PROSPERO CRD420251075109.

Background Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and increases stroke risk, primarily due to thromboembolism from the left atrial appendage (LAA). Oral anticoagulation (OAC) is recommended, but data on LAA thrombus (LAAT) in HCM and AF are limited. The current study aimed to assess LAAT prevalence in patients with HCM and AF. Methods We retrospectively analyzed 170 patients with HCM and AF (mean age, 67.7±12.4 years; 57.1% men) who underwent at least one transesophageal echocardiogram (TEE) during a median follow‐up of 41.5 months (interquartile range, 15–77 months). Results At the time of TEE, 147 (86.5%) patients were undergoing OAC, with 52 (30.6%) taking vitamin K antagonists and 95 (55.9%) taking non–vitamin K antagonist oral anticoagulants. LAAT was found in 36 patients (21.2%), with prevalence rates of 23.1% (n=12) in vitamin K antagonist users, 16.8% (n=16) in non–vitamin K antagonist oral anticoagulant users, and 34.8% (n=8) in those without OAC. Non–vitamin K antagonist oral anticoagulant use was associated with a significant LAAT risk reduction compared with no OAC (odds ratio, 0.20 [95% CI, 0.05–0.73]; P =0.02). Decreased LAA flow velocity ( P <0.001) was independently linked to LAAT. Conclusions LAAT is common in patients with HCM and AF, even among those receiving OAC. Reduced LAA flow velocity may increase thrombus risk. TEE should be considered before rhythm‐control strategies, even in patients with HCM receiving anticoagulation, to minimize thromboembolic complications.

BACKGROUND:Catheter ablation is an established therapy for ventricular tachycardia (VT) in structural heart disease (SHD), but radiofrequency ablation is limited by lesion depth and challenges in targeting intramural substrate. Pulsed field ablation (PFA) induces irreversible electroporation and may offer advantages for ventricular substrate modification. However, clinical data on focal PFA for VT remain limited. OBJECTIVE:This study aimed to evaluate procedural characteristics, acute efficacy, safety, and outcomes of focal PFA for VT in patients with SHD. METHODS:In this single-center study, 16 consecutive patients with SHD underwent VT ablation using focal PFA. Acute success was defined as noninducibility of any sustained or nonsustained VT at the end of the procedure. VT recurrence during follow-up was assessed by implantable cardioverter-defibrillator interrogation and Holter monitoring. RESULTS:The mean age was 66 ± 11 years, 9 patients (64%) had nonischemic cardiomyopathy, and the mean left ventricular ejection fraction was 43% ± 11%. Septal substrate was targeted in 11 patients (69%). The mean procedure time was 138 ± 34 minutes, with 58 ± 26 PFA applications per case. Acute procedural success was achieved in 14 of 16 patients (88%). Major complications occurred in 1 patient (6%), who developed pericardial tamponade; no deaths, strokes, or myocardial infarctions occurred. During a median follow-up of 130 days, VT recurred in 3 patients, yielding 81% freedom from VT recurrence. CONCLUSION:Focal PFA for VT in SHD was feasible and was associated with high acute noninducibility and encouraging early freedom from VT recurrence, including in predominantly septal substrates. Larger studies are needed to define durability and optimal dosing strategies.

Pulsed field ablation (PFA) is a nonthermal energy modality that selectively targets myocardial cells through irreversible electroporation. It has gained widespread adoption for atrial arrhythmias owing to its favorable safety profile and ability to produce deeper lesions than traditional thermal ablation.1,2 With the development of focal PFA catheters, this technology is increasingly being explored for the treatment of ventricular arrhythmias, including premature ventricular contractions (PVCs), with early multicenter studies showing acute success rates of up to 85%. 3,4 Despite its selective tissue effect, coronary vasospasm has emerged as a complication, particularly during focal PFA near coronary structures.5,6 Although some reports demonstrated feasibility near the coronary venous system without spasm,4 the risk remains incompletely characterized. We describe progressive coronary spasm despite prophylactic intravenous (IV) nitroglycerin during focal PFA for symptomatic PVCs delivered via the great cardiac vein (GCV), highlighting both therapeutic potential and vascular safety considerations of PFA near coronary arteries.

AIMS:Ventricular tachycardia (VT) in ischaemic heart disease (IHD) requires complex management strategies including catheter ablation (CA) and anti-arrhythmic drugs (AADs). The aim of this study is to compare efficacy and safety of CA vs. AADs in patients with IHD and VT. METHODS AND RESULTS:We performed a meta-analysis of randomized controlled trials (RCTs) enrolling patients with IHD and ICD randomized to CA or AADs. Primary outcome was appropriate ICD therapy. Secondary outcomes included inappropriate ICD therapy, cardiovascular (CV) re-hospitalization, all-cause/CV mortality, and adverse events. Subgroup analyses were conducted for amiodarone and sotalol, with an exploratory evaluation of a composite endpoint (ICD shock, VT storm, all-cause death). Four RCTs including 947 patients (mean age 68 ± 2 years; 93% male) were analysed. CA significantly reduced the risk of appropriate ICD therapy compared with AADs (149/470 [31.7%] vs. 229/477 [48.0%]; RR 0.81; 95% CI [0.67, 0.97]; P = 0.02). Among secondary outcomes, CA decreased the incidence of CV re-hospitalization [RR 0.84; 95% CI (0.72, 0.99); P = 0.04] and adverse events [RR 0.42; 95% CI (0.28, 0.62); P < 0.01], while no differences were observed in all-cause/CV mortality and inappropriate ICD therapy. In subgroup analyses, CA was superior to sotalol in reducing the composite endpoint of ICD shock, VT storm and all-cause death [RR: 0.82, 95% CI (0.69, 0.98), P = 0.03]; whereas, no significant benefit was seen compared to amiodarone [RR: 0.92; 95% CI (0.78, 1.09), P = 0.32]. CONCLUSION:In ischaemic heart disease and VT, CA compared with anti-arrhythmic drugs is associated with a reduction of appropriate ICD therapy, cardiovascular re-hospitalization, and adverse events with benefits most evident versus sotalol.

Aims:The 2020 European Society of Cardiology (ESC)-atrial fibrillation (AF) guidelines recommend a risk-based approach to oral anticoagulation (OAC) therapy in patients with AF; however, it is unknown if current practice aligns with these recommendations. This study assessed the associated effectiveness and safety of edoxaban in patients with AF according to the 2020 ESC-AF guidelines and the approved label in routine clinical care. Methods and results:The Global ETNA-AF programme is a large prospective, noninterventional programme evaluating safety and effectiveness of edoxaban. Baseline characteristics and 2-year clinical event data were analysed in subgroups, defined by ESC-AF guidelines indication of OAC therapy according to CHA2DS2-VASc score [no OAC to be considered, OAC should be considered (2 for females/1 for males), and OAC recommended (≥3 for females/≥2 for males)] and modified HAS-BLED score [(≥3 (bleeding risk high) vs. <3 (bleeding risk low)]. Of 19 960 patients included, 16 912 (84.7%) were categorized as OAC recommended and 2501 (12.5%) as OAC should be considered; 547 (2.7%) were in the no OAC to be considered group. In the OAC recommended group, 12 006 (71.0%) had high bleeding risk. Clinical event rates were <5%/year across all risk groups, even in the OAC recommended and high bleeding risk groups. In the OAC recommended and high bleeding risk groups, patients had low ischaemic stroke and bleeding event rates, regardless of receiving the 30 or 60 mg dose. Conclusion:This study demonstrated that edoxaban use in patients with AF largely aligns with 2020 ESC-AF guidelines, while maintaining low clinical event rates. Registration:Europe (NCT02944019), Japan (UMIN000017011), and Korea/Taiwan (NCT02951039).

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

BackgroundElectrographic flow (EGF) mapping enables full spatiotemporal reconstruction of organized wavefront propagation to identify extrapulmonary vein sources of atrial fibrillation (AF).ObjectivesFLOW-AF (A Randomized Controlled Study to Evaluate the Reliability of the Ablacon Electrographic FLOW [EGF] Algorithm Technology [Ablamap Software] to Identify AF Sources and Guide Ablation Therapy in Patients With Persistent Atrial Fibrillation) was multicenter, randomized controlled study of EGF mapping to: 1) stratify a nonparoxysmal AF population undergoing redo ablation; 2) guide ablation of these extrapulmonary vein AF sources; and 3) improve AF recurrence outcomes.MethodsFLOW-AF enrolled persistent atrial fibrillation (PerAF)/long-standing PerAF patients undergoing redo ablation at 4 centers. One-minute EGF maps were recorded from standardized biatrial basket positions. Patients with source activity ≥26.5% were randomized 1:1 to PVI + EGF-guided ablation vs PVI only; patients without sources ≥26.5% threshold were not randomized. Follow-up and electrocardiographic monitoring occurred at 3, 6, and 12 months.ResultsWe enrolled 85 patients (age 65.6 ± 9.3 years, 37% female, 24% long-standing PerAF). Thirty-four (40%) patients had no sources greater than threshold; at least 1 source greater than threshold was present in 46 (60%) (EGF-guided ablation, n = 22; control group, n = 26). Patients with sources were older (68.2 vs 62.6 years; P = 0.005) with higher CHA2DS2-VASc scores (2.8 vs 1.9; P = 0.001). The freedom from safety events was 97.2%, and 95% of EGF-identified sources were successfully ablated. In randomized patients, AF-free survival at 12 months was 68% for EGF-guided ablation vs 17% for the control group (P = 0.042); freedom from AF/atrial tachycardia/atrial flutter at 12 months was 51% vs 14% (P = 0.103), respectively.ConclusionsIn nonparoxysmal AF patients undergoing redo ablation, EGF mapping identified AF sources in 60% of patients, and could be successfully ablated in 95%. Compared with PVI alone, PVI + source ablation improved AF-free survival by 51% on an absolute basis. (FLOW-AF: A Study to Evaluate the Ablacon Electrographic FLOW EGF Technology [A Randomized Controlled Study to Evaluate the Reliability of the Ablacon Electrographic FLOW (EGF) Algorithm Technology (Ablamap Software) to Identify AF Sources and Guide Ablation Therapy in Patients With Persistent Atrial Fibrillation]; NCT04473963)

Background Non-vitamin-K oral anticoagulants (NOACs) are safe and effective for stroke prevention in patients with atrial fibrillation (AF). Data on the safety and efficacy of Edoxaban in routine care in Germany, Austria and Switzerland (DACH) are limited. We report one-year outcomes in patients with AF treated with Edoxaban in routine care. Methods The ETNA-AF-Europe study (Clinicaltrials.gov:NCT02 944 019) is a multicenter, prospective, observational study that enrolled 13 092 patients with AF treated with Edoxaban from 852 sites across 10 European countries (Austria, Belgium, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Switzerland, and the United Kingdom). The DACH-cohort consists of 5457 (41,7 %) patients of sites in Germany, Austria and Switzerland. Results Patients had a mean age of 74 years (2384 [44 %]women) and a mean CHA(2)DS(2)-VASc-score of 3.2 +/- 1.4. A label-conform dosing of Edoxaban was administered to 4309 patients (78,9 %). At the one-year-follow-up a stroke or systemic embolism occurred in 42 patients (0,8 %/year), and severe bleeding was reported in 36 patients (0,7 %/year). Ten patients (0,2 %/year) suffered intracranial and 13 patients (0,3 %/year)gastrointestinal bleeding. Numbers of death from all causes and cardiovascular death occurred in 179 patients (3,4 %/year) and 85 patients (1,6 %/year), respectively. Age > 75 years, frailty and a CHA(2)DS(2)-VASc score >= 4 were associated with a higher all-cause mortality - and those patients were more likely to suffer a stroke or a major bleeding event. Conclusion In Germany, Austria and Switzerland in patients with AF on Edoxaban therapy for stroke prevention the number of stroke and major bleeding events is low. Increasing morbidity is associated with a higher number of important clinical events.

BACKGROUND Electrographic flow (EGF) mapping enables the dy-namic detection of functional or active atrial fibrillation (AF) sour-ces outside the pulmonary veins (PVs), and the presence or absence of these sources offers a novel framework for classifying and treat-ing persistent AF patients based on the underlying pathophysiology of their AF disease.OBJECTIVE The primary objective of the FLOW-AF trial is to eval-uate the reliability of the EGF algorithm technology (Ablamap soft-ware) to identify AF sources and guide ablation therapy in patients with persistent AF.METHODS The FLOW-AF trial (NCT04473963) is a prospective, multicenter, randomized clinical study in which patients with persistent or long-standing persistent AF who have failed prior PV isolation (PVI) undergo EGF mapping after confirmation of intact PVI. In total, 85 patients will be enrolled and stratified based on the presence or absence of EGF-identified sources. Patients with an EGF-identified source above the predetermined activity threshold of 26.5% will be randomized in a 1:1 fashion to PVI only vs PVI 1 ablation of EGF-identified extra-PV sources of AF.RESULTS The primary safety endpoint is freedom from serious adverse events related to the procedure through 7 days following the randomization procedure; and the primary effectiveness endpoint is the successful elimination of significant sources of exci-tation with the target parameter the activity of the leading source. CONCLUSIONS The FLOW-AF trial is a randomized study designed to evaluate the ability of the EGF mapping algorithm to identify pa-tients with active extra-PV AF sources.

BACKGROUND A novel multielectrode radiofrequency balloon (RFB) catheter has been released for pulmonary vein isolation (PVI).Methods and Results: In this observational study consecutive patients with drug-refractory paroxysmal or persistent atrial fibrillation (AF) undergoing first-time PVI were enrolled in 2 high-volume ablation centers. All procedures were conducted in conjunction with a 3D-mapping system. Clinical, procedural and ablation parameters were systematically analyzed. 105 patients (58% male; 52% paroxysmal AF, 68±11.3 years mean age, left atrial volume index 38.6±14.8 mL/m2) were included. 241/412 (58.5%) PVs were successfully isolated with a single shot (SS), with a time-to-isolation of 11.6±8 s. Total number of radiofrequency applications was 892 (mean 2.2/PV), resulting in successful isolation of 408/412 (99%) PVs at the end of the procedure. Mean electrodes' impedance drop was significantly higher in the SS-PVI compared with non-SS applications (21.5±6.6 vs. 18.6±6.5 Ohm). Concordantly, higher temperature rise was observed in the SS vs. non-SS applications (10.9±4.9℃ vs. 9.6±4.7℃). CONCLUSIONS In this multicenter real-world study, mean impedance drop and temperature rise were associated with successful SS-PVI applying the novel RFB catheter. These parameters may help to guide efficient usage of the new RF balloon.

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): FARAPULSE, Inc. Introduction Thermal energy sources damage the entire atrial tissue during pulmonary vein isolation (PVI) including cardiac nerves and ganglia. This induces a postinterventional increase in heart rate. Pulsed-field ablation (PFA), a new non-thermal energy source for PVI, primarily damages cardiomyocytes by electroporation. Whether use of PFA reduces damage to cardiac nerves and ganglia and influences postinterventional increase of heart rate is not known. Purpose We compared the acute effects of PFA with a pentaspline catheter and cryoballoon ablation (CBA) on secretion of circulating biomolecules reflecting cardiomyocyte and neuronal injury and postinterventional increase in heart rate to estimate damage to the cardiac autonomic nervous system and autonomic dysfunction after PVI. Methods Blood samples were taken before and after PVI in consecutive patients undergoing PFA and CBA. All patients participated in the TRUST registry. Serum concentrations of high-sensitive Troponin I (hsTropI, Immunoassay) and S100b (ELISA), a surrogate marker for neuronal injury, were quantified in blood samples taken prior to PVI and directly after PVI. Pre- and postinterventional heart rates were measured in ECGs and Holter-ECGs. Results Fifty-six patients underwent PVI, either by PFA (n=28, age 63 [54; 75] y, 64% males, 57% persistent AF) or CBA (n=28, age 71 [62; 78] y, 61% males, 54% persistent AF). All 112 blood samples were analyzable. Acute success of PVI was 100% in both groups without major complications, especially, no TIA and no stroke. After CBA, one patient suffered from phrenic palsy, which reversed after 3 months. HsTropI increased 3.3-fold more after PFA compared to CBA (625±138 vs. 185±42 pg/ml; p=0.004) suggesting more damage to cardiomyocytyes. S100b increased 2.9-fold less after PFA compared to CBA (21.1±3.7 vs. 61.2±8.1 pg/ml; p<0.001). The ratio of ∆S100b/∆hsTropI was five-fold smaller after PFA compared to CBA (0.19±0.1 vs. 0.98±0.3; p=0.007), suggesting a lower neurocardiac injury in comparison to lesion size. Concomitantly, increase in heart rate at the postinterventional day was smaller in PFA (-0.2±3.0 bpm; n=45) than in CBA (+6.1±2.7 bpm, n=15; p=0.024). Conclusion This study in patients validates the experimental concept that PFA-based AF ablation leads to more specific damage to cardiomyocytes than to cardiac nerves and ganglia, reflected by lower S100B concentrations and no post-interventional heart rate increase compared to CBA.

Abstract Funding Acknowledgements Type of funding sources: None. Background Mitral ishmus ablation is an established approach to treat perimitral reentrant tachycardia, and is often performed as substrat modification in patients with persistent atrial fibrillation (AF). Bidirectional block of the mitral isthmus line (MIL) is still a great challenge using conventional ablation catheters, but is essential to prevent recurrence of atrial arrhythmia. Recently, the novel DiamondTempTM (DT) ablation system was introduced and allows for high-power, short-duration ablation in a temperature-controlled mode. Its use during pulmonary vein isolation (PVI) using a recommended ablation setting with a catheter-tip temperature limit of 60°C, a temperature-controlled power of 50 W and an application duration of 10 sec has shown to be effective and safe. However, data on DT ablation settings for substrate modification, i.e., creation of linear lesions are lacking. Aim The aim of the present study was to evaluate acute efficacy and safety of the novel DT ablation system for bidirectional block of the MIL using two different protocols. Methods The study population comprised 14 patients [67±8 years, 10/14 male (71%)] suffering from persistent AF and/or atrial tachycardia who underwent catheter re-ablation with creation of a MIL using the DT ablation system. Ablation settings were a catheter-tip temperature limit of 60°C, a temperature-controlled power of 50 W with an application duration of either 10 sec (group A, n=7) or 20 sec (group B, n=7). Additional epicardial ablation from within the coronary sinus with a temperature limit of 60°C, a temperature-controlled power of 20 W and an application duration of 20 sec was performed, if bidirectional block could not be achieved with endocardial ablation only. Results Mean procedure and fluoroscopy time, and dose area product for group A and group B were 103±24 vs. 119±38 min, 12±5 vs. 13±4 min, and 572±270 vs. 537±202 cGycm, respectively. Bidirectional block of the MIL was achieved in 7/7 (100%) patients in group A and in 6/7 (86%) patients in group B. Additional epicardial ablation was required in 6/7 patients (86%) in group A and in 4/7 (57%) patients in group B. In group B, bidirectional block of the MIL required fewer endocardial (31±11 vs. 26±10 applications) as well as epicardial RF-applications (10±6 vs. 7±3 applications). Pericardial effusion without hemodynamic relevance occurred in 1/7 (14%) patients of group B. No further complications occurred. Conclusion Catheter ablation of the MIL using the novel DT ablation system is safe and associated with high acute efficacy. A lower number of RF-applications and a less frequent need for additional epicardial ablation was observed when applying longer RF-applications of 20 sec. Further analyses are warranted to confirm these findings.

Purpose Pulsed-field ablation (PFA) is a new energy source to achieve pulmonary vein isolation (PVI) by targeted electroporation of cardiomyocytes. Experimental and controlled clinical trial data suggest good efficacy of PFA-based PVI. We aimed to assess efficacy, safety and follow-up of PFA-based PVI in an early adopter routine care setting. Methods Consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) underwent PVI using the Farawave® PFA ablation catheter in conjunction with three-dimensional mapping at two German high-volume ablation centers. PVI was achieved by applying 8 PFA applications in each PV. Results A total of 138 patients undergoing a first PVI (67 ± 12 years, 66% male, 62% persistent AF) were treated. PVI was achieved in all patients by deploying 4563 applications in 546 PVs (8.4 ± 1.0/PV). Disappearance of PV signals after the first application was demonstrated in 544/546 PVs (99.6%). More than eight PFA applications were performed in 29/546 PVs (6%) following adapted catheter positioning or due to reconnection as assessed during remapping. Mean procedure time was 78 ± 22 min including pre- and post PVI high-density voltage mapping. PFA catheter LA dwell-time was 23 ± 9 min. Total fluoroscopy time and dose area product were 16 ± 7 min and 505 [275;747] cGy*cm 2 . One pericardial tamponade (0.7%), one transient ST-elevation (0.7%) and three groin complications (2.2%) occurred. 1-year follow-up showed freedom of arrhythmia in 90% in patients with paroxysmal AF ( n = 47) and 60% in patients with persistent AF ( n = 82, p = 0.015). Conclusions PFA-based PVI is acutely highly effective and associated with a beneficial safety and low recurrence rate. Graphical abstract

Background EAST‐AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial) demonstrated clinical benefit of early rhythm‐control therapy (ERC) in patients with new‐onset atrial fibrillation (AF) and concomitant cardiovascular conditions compared with current guideline‐based practice. This study aimed to evaluate the generalizability of EAST‐AFNET 4 in routine practice. Methods and Results Using a US administrative database, we identified 109 739 patients with newly diagnosed AF during the enrollment period of EAST‐AFNET 4. Patients were classified as either receiving ERC, using AF ablation or antiarrhythmic drug therapy, within the first year after AF diagnosis (n=27 106) or not receiving ERC (control group, n=82 633). After propensity score overlap weighting, Cox proportional hazards regression was used to compare groups for the primary composite outcome of all‐cause mortality, stroke, or hospitalization with the diagnoses heart failure or myocardial infarction. Most patients (79 948 of 109 739; 72.9%) met the inclusion criteria for EAST‐AFNET 4. ERC was associated with a reduced risk for the primary composite outcome (hazard ratio [HR], 0.85; 95% CI, 0.75–0.97 [P=0.02]) with largely consistent results between eligible (HR, 0.89; 95% CI, 0.76–1.04 [P=0.14]) or ineligible (HR, 0.77; 95% CI, 0.60–0.98 [P=0.04]) patients for EAST‐AFNET 4 trial inclusion. ERC was associated with lower risk of stroke in the overall cohort and in trial‐eligible patients. Conclusions This analysis replicates the clinical benefit of ERC seen in EAST‐AFNET 4. The results support adoption of ERC as part of the management of recently diagnosed AF in the United States.

Despite advances in safety and efficacy of pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence remains a common problem after PVI for rhythm-control treatment of AF. PV reconduction is frequently observed during AF reablation procedures. Several factors including patients’ anatomy and energy source predispose to electrical reconduction of PVs and might have an impact on patient management, e.g., to devote specific attention to certain veins during index procedures.

Pulsed-field ablation (PFA) is a new energy source to perform pulmonary vein isolation (PVI) by targeted electroporation of cardiomyocytes. Integrated into a single-shot device, PFA has the potential to increase efficacy and safety of PVI compared to thermal energy sources.