What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=341). Intervention: Pulsed-field ablation (PFA). Primary outcome: Durable pulmonary vein isolation at redo procedure (per-vein level).

July 31, 2023Journal of Interventional Cardiac ElectrophysiologyOpen Access

Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation

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Key result

PFA shows ~63% durable PVI per-vein in patients with arrhythmia recurrence.

n=341

Why the study?

Pre-market data showed high rates of PVI durability with a novel multipolar PFA catheter, but post-market data in patients with recurrent arrhythmias were needed.

What is the rate of durable pulmonary vein isolation in patients with recurrent arrhythmia after pulsed-field ablation?

Population

29 patients with recurrent arrhythmias undergoing redo ablation after index PFA PVI (out of 341 treated)

Comparison

Redo 3D-EAM vs post-ablation index 3D-EAM

Design

Observational study of consecutive patients

Follow-up

Median of 6 months

Authors

TKThomas KuefferElectrophysiology ASAnita StefanovaUniversity of Bern AMAntonio MadaffariElectrophysiology

Discussion

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Implication

Post-market redo data after PFA PVI remain hypothesis-generating; larger prospective studies needed to confirm durability.

Study Design

Type

Observational (n=341)

Multicenter

Structured PICO

What is the rate of durable pulmonary vein isolation in patients with recurrent arrhythmia after pulsed-field ablation?

Population

341 patients with paroxysmal or persistent atrial fibrillation who underwent index pulmonary vein isolation using pulsed-field ablation, of which 29 underwent a repeat procedure for recurrent arrhythmias after a median of 6.2 months.

Intervention

Pulsed-field ablation (PFA) for pulmonary vein isolation (PVI)

Outcome

PVI durability assessed on a per-vein and per-patient levelsurrogate

In patients with recurrent arrhythmia after pulsed-field ablation, durable pulmonary vein isolation was found in 63% of veins, with only minor lesion regression observed.

Limitations

Retrospective observational single-center study design.
Only 50% of patients with recurrence underwent repeat ablation, potentially introducing selection bias.
Definition of PV reconnection and identification of reconnection sites can be subjective in ambiguous cases.
Lesion regression quantification is challenging due to varying map quality, spatial density, and the presence of reconnected veins.

Cite This Study

Kueffer et al. (2023) conducted an observational in Atrial fibrillation (n=341). Pulsed-field ablation (PFA) was evaluated on Durable pulmonary vein isolation at redo procedure (per-vein level). In patients with arrhythmia recurrence after pulsed-field ablation, durable pulmonary vein isolation was observed in 63% of previously isolated veins, with 21% of patients showing durable isolation of all veins.

synapsesocial.com/papers/6a5bc6d868f4367e1704c41f https://doi.org/10.1007/s10840-023-01608-7

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes

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Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider