Western Atrial Fibrillation Symposium 2026: Session 4 Roundtable 

Redo Ablation After Failed Pulsed Field Ablation—Go for Hybrid, Stick With Pulses or Switch to Thermal?

• Atrial fibrillation (AF); pulsed field ablation (PFA); redo procedures: Panelists reported that routine conversion to radiofrequency (RF) ablation alone after failed PFA is uncommon. Redo strategy is typically individualized based on AF recurrence pattern (paroxysmal vs persistent), lesion durability, pulmonary vein isolation (PVI) status, substrate characteristics, and presence of atrial flutter/tachycardia triggers.
• Persistent AF and recurrent AF after PFA: Experts emphasized evaluating for pulmonary vein reconnection, posterior wall involvement, superior vena cava (SVC) triggers, atrial tachycardias, and scar-related substrate. Several speakers discussed high-density mapping, MRI-based scar assessment, computational modeling, focal spatiotemporal dispersion mapping, and electrographic flow mapping as tools that may help guide patient-specific reablation strategies.
• Evidence gaps and future directions: Panelists highlighted limited evidence on optimal redo strategies after failed PFA and emphasized the need for additional studies, comparative effectiveness research, and patient-specific evaluation using mapping, imaging, and trigger assessment to guide reablation decisions.

Reviewed by Jodie Elrod, Managing Editor