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Pulsed-field ablation-based pulmonary vein isolation: acute safety, efficacy and short-term follow-up in a multi-center real world scenario.


ABSTRACT:

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*cm2. 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.

SUBMITTER: Lemoine MD 

PROVIDER: S-EPMC10241704 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Pulsed-field ablation-based pulmonary vein isolation: acute safety, efficacy and short-term follow-up in a multi-center real world scenario.

Lemoine Marc D MD   Fink Thomas T   Mencke Celine C   Schleberger Ruben R   My Ilaria I   Obergassel Julius J   Bergau Leonard L   Sciacca Vanessa V   Rottner Laura L   Moser Julia J   Kany Shinwan S   Moser Fabian F   Münkler Paula P   Dinshaw Leon L   Kirchhof Paulus P   Reissmann Bruno B   Ouyang Feifan F   Sommer Philipp P   Sohns Christian C   Rillig Andreas A   Metzner Andreas A  

Clinical research in cardiology : official journal of the German Cardiac Society 20220922 6


<h4>Purpose</h4>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.<h4>Methods</h4>Consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) underwent PVI using the Farawave® PFA ablati  ...[more]

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