Key result
PFA substrate modification in long-standing persistent AF yields ~44% 1-year arrhythmia recurrence.
Why the study?
Data on the efficacy and safety of left atrial substrate modification using a single-shot PFA system in patients with long-standing persistent AF and LAMRT were scarce.
Left atrial substrate modification using a single-shot pulsed field ablation (PFA) system in patients with long-standing persistent AF appears acutely effective and safe, providing a potential alternative to radiofrequency ablation for complex cases.
Single-shot PFA substrate modification appears feasible and safe acutely in this small series; leaves open its impact on 1-year recurrence in long-standing persistent AF.
Background: Pulsed field ablation [PFA] is a novel ablation technique for pulmonary vein isolation [PVI] in patients with paroxysmal and persistent atrial fibrillation. However, data for the efficacy and safety of PFA for left atrial substrate modification using a single shot PFA system, in patients with long-standing persistent atrial fibrillation [AF] and left atrial macro- as well as micro-reentrant atrial tachycardia [LAMRT], are scarce. Here, we provide a small, single-center case series regarding the efficacy and safety of left atrial substrate modification using a single-shot PFA system. Methods: Nine patients with long-standing persistent AF and LAMRT underwent redo-PVI and left atrial substrate modification using a single-shot PFA system. Patients were subsequently followed up for 1 year. Results: The median age was 64 years [IQR 55.5–75], with 44% of the participants being female. The median time since the first diagnosis of AF was 7 years [IQR 4–15.5]. After re-PVI, posterior wall isolation was performed in five patients, roof isolation in six patients, and anterior wall ablation between the superior mitral annulus and the right superior pulmonary vein [RSPV] in five patients. In two patients, cavotricuspid isthmus ablation was additionally performed to treat typical atrial flutter. The acute procedural success rate was 100%, with all LAMRTs and typical flutters successfully terminating by ablation. At 1-year follow-up, four patients [44%] experienced a recurrence of any atrial arrhythmia. Median time to recurrence was 164 days [138–212.8]. Importantly, no acute or chronic complications were observed. Conclusions: In this small, single-center case series, left atrial substrate modification for long-standing persistent AF and AT using a single-shot PFA system was safe and showed an excellent acute success rate.
No takes yet. Share an insight, caveat, or question.
Lustig et al. (2025) studied Long-standing persistent atrial fibrillation and left atrial macro- or micro-reentrant tachycardia (n=9). Single-shot Pulsed Field Ablation (PFA) was evaluated on Recurrence of documented atrial arrhythmia >30 s. Pulsed field ablation for left atrial substrate modification in long-standing persistent atrial fibrillation achieved 100% acute success and a 44% 1-year recurrence rate, with no complications.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: