Pulsed field ablation significantly reduced the risk of atrial tachyarrhythmia recurrence compared to radiofrequency ablation (24% vs. 36%; HR 0.56, 95% CI 0.35-0.90, P=0.017).
Cohort (n=253)
Does pulsed field ablation using focal contact force-sensing catheters reduce the recurrence of atrial arrhythmias in patients with recurrent atypical left atrial flutter compared to radiofrequency ablation?
Contact force-guided pulsed field ablation significantly reduces the recurrence of atrial tachyarrhythmias compared to conventional radiofrequency ablation in patients with refractory left atrial flutter.
Effect estimate: HR 0.56 (95% CI 0.35-0.90)
Absolute Event Rate: 24% vs 36%
p-value: p=0.017
BACKGROUND: While tissue contact significantly impacts pulsed field ablation (PFA) efficacy, evidence supporting contact force-guided PFA for recurrent left atrial flutter (AFL) remains scarce. This study investigates the efficacy and safety of PFA in this difficult-to-treat population compared to radiofrequency ablation (RFA). METHODS: Patients with atypical AFL who had undergone at least one prior persistent AF ablation were prospectively enrolled for PFA and compared with a retrospectively analyzed control group treated with conventional radiofrequency ablation (RFA) at the same period. Coronary artery spasm risk was assessed via coronary angiography. The efficacy endpoints were recurrence of atrial arrhythmias after 3 months blanking period. The safety endpoint included severe procedure-related complications. RESULTS: A total of 253 patients were included in this study (mean age 59, 68% being male), 119 patients received PFA treatment, 134 patients received RFA. At 12-month follow-up, the RFA group demonstrated a significant higher atrial tachyarrhythmia recurrence rate compared to the PFA group (36% vs. 24%; log-rank P = 0.027). In the multi-variable Cox regression model, PFA was linked to lower risk of the recurrence risk compared to RFA (Hazard ratio: 0.56, 95% confidential interval: 0.35-0.90, P = 0.017). Moreover, acute MI block rate in PFA group was significantly higher than in RFA group (100% vs 64%, P < 0.001). No procedure-related complications were observed, including esophageal fistula, phrenic nerve injury, and coronary artery spasm. CONCLUSION: In patients with refractory left AFL post-AF ablation, contact force-guided PFA appears promising and demonstrates favorable efficacy compared with conventional RFA..
Ding et al. (Fri,) conducted a cohort in Recurrent left atrial flutter (AFL) (n=253). Pulsed field ablation (PFA) vs. Conventional radiofrequency ablation (RFA) was evaluated on Recurrence of atrial arrhythmias after 3 months blanking period (HR 0.56, 95% CI 0.35-0.90, p=0.017). Pulsed field ablation significantly reduced the risk of atrial tachyarrhythmia recurrence compared to radiofrequency ablation (24% vs. 36%; HR 0.56, 95% CI 0.35-0.90, P=0.017).