117 Real world observational study of pulsed-field ablation for pulmonary vein isolation in a tertiary center in the United Kingdom

Introduction Pulsed-field ablation (PFA) is a new, non-thermal ablation modality, which uses electrical impulses for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The study presents the experience of a tertiary cardiac centre in the UK in terms of safety and acute efficacy for a pentaspline, multi-electrode PFA catheter. Methods and results A local registry of patients who had PVI using PFA with Farapulse™ PFA ablation system (Boston Scientific, Menlo Park, CA, USA) was prospectively observed and analysed. A total of 66 patients underwent PVI ablation with PFA between March 2023 and January 2024. 45 of them (68.1%) were male and the mean age of the group was 62.4 years. The patients were equally divided between paroxysmal and persistent atrial fibrillation. 14 (21.2%) patients had tachycardia-induced cardiomyopathy with LVEF <45%. 5 (7.57%) patients had prior AF ablation. All procedures were done in the presence of an anaesthetic team. In 34 patients we used general anaesthesia, and in the remaining 32 patients - intravenous sedation directed by an anaesthetist ("deep sedation"). Mean lab time (door to door) was 120.1(± 41.4) minutes and procedure time (skin to skin) was 84(±36.8) minutes. 17 patients (25.8%) had an ablation beyond PVI – 7 (10.6%) had additional left atrial ablation with PFA (6 patients) or radiofrequency ablation (1 patient) and 10 patients (15.2%) had an additional ablation for CTI-dependent flutter. In 8 patients (12.1%) we used a 3D mapping system. All 66 patients had acutely successful PVI. The mean fluoroscopy time was 25.2 (± 10.6) minutes, and the mean dose-area-product (DAP) was 810 (± 599.3) cGy.cm2. 65 patients were discharged on the same day or the next day after the procedure. Only one patient had a major complication – cardiac tamponade requiring pericardiocentesis during the procedure and was implanted with a permanent pacemaker because of AF with slow ventricular response. 2 patients (3%) had mild pericardial effusion at the end of the procedure without haemodynamic significance. No cerebrovascular events, phrenic nerve palsy, atrio-oesophageal fistula or periprocedural mortality occurred. Conclusion This local registry data from a high-volume tertiary electrophysiology centre demonstrated a high acute PVI success rate with a safety profile comparable to existing modalities and short procedure times in a real-world AF patient population. Conflict of Interest None