Pulsed-field ablation achieved 100% acute electrical pulmonary vein isolation in patients with atrial fibrillation, with a 0.7% major complication rate.
Observational (n=138)
Yes
Does pulsed-field ablation achieve effective and safe pulmonary vein isolation in patients with symptomatic paroxysmal or persistent atrial fibrillation?
Pulsed-field ablation for pulmonary vein isolation is highly effective acutely and demonstrates a favorable safety profile with low recurrence rates in a real-world setting.
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*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
Lemoine et al. (2022) conducted an observational in Symptomatic paroxysmal or persistent atrial fibrillation (n=138). Pulsed-field ablation (Farawave catheter) was evaluated on Electrical pulmonary vein isolation (PVI). Pulsed-field ablation achieved 100% acute electrical pulmonary vein isolation in patients with atrial fibrillation, with a 0.7% major complication rate.
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