Key result
Pulsed field ablation successfully terminated all 29 atrial tachycardias resistant to prior radiofrequency ablation in 19 patients, rendering them non-inducible with no complications.
Why the study?
There is limited knowledge of the immediate and long-term efficacy of pulsed field ablation for residual AT following persistent AF ablation that is resistant to prior RFA.
Does pulsed field ablation terminate atrial tachycardia resistant to prior radiofrequency ablation in patients with prior persistent atrial fibrillation ablation?
Observational (n=19)
Does pulsed field ablation terminate atrial tachycardia resistant to prior radiofrequency ablation in patients with prior persistent atrial fibrillation ablation?
Pulsed field ablation can effectively and safely terminate complex or epicardial atrial tachycardia sources that are resistant to radiofrequency ablation.
PFA may terminate resistant AT acutely after failed RFA; leaves open durability and safety in prospective trials.
Funding Acknowledgements Type of funding sources: None. Background There is a limited knowledge of immediate and long-term efficacy of pulsed field ablation for residual atrial tachycardia (AT) following (longstanding) persistent atrial fibrillation (AF) ablation and resistant to prior radiofrequency ablation (RFA). Purpose To present immediate effects of PFA (Farapulse) in a series of patients with repeat ablation for residual atrial tachycardia (AT) resistant to prior RFA. Methods and results In 5-11/2022, of 23 patients scheduled for PFA, 19 patients (64±7 years, 3 females) underwent PFA for left atrial (LA) AT resistant to RFA in first (n=4), second (n=11), third (n=3), and fourth (n=1) repeat ablation, respectively, after primary persistent AF ablation (4 patients were redirected to RFA for septal/right atrial AT source found by 3D mapping). At the procedure onset, persistent AT was ongoing (n=15) or was induced (n=4; AF induced and subsequently converted into AT in 3 patients). Mapping/ablation strategy was directed according to CS activation/entrainment to: 1) no 3D mapping and direct PFA (n=11); 2) PFA directly after 3D LA mapping (n=5); 3) PFA following RFA after 3D LA mapping (n=3). Total of 29 ATs was found (1,2, and 3 ATs in 12, 4, and 3 patients, respectively). Localized AT sources (n=16) dominated over macroreentry (MR) ATs (8 perimitral, 4 roof-dependent, 1 typical flutter). Only MR ATs, only localized ATs, and both MR+localized ATs were present in 7, 4, and 8 patients, respectively. All ATs were stopped with 5±9 PFA applications at the site of AT source and remained non-inducible. In 3 patients with initial ineffective RFA (6, 11, 6 minutes) within the same procedure, subsequent PFA terminated the AT with 1, 4, and 1 application respectively. Procedure and fluoroscopy times were 104±29 and 12±4 minutes, no complication occurred. Conclusion PFA with catheter Farapulse can affect complex/epicardial AT sources resistant to RFA in prior or present ablation procedure.
No takes yet. Share an insight, caveat, or question.
Fiala et al. (2023) conducted an observational in Residual atrial tachycardia following persistent atrial fibrillation ablation (n=19). Pulsed field ablation (Farapulse) was evaluated on Termination of atrial tachycardia and non-inducibility. Pulsed field ablation successfully terminated all 29 atrial tachycardias resistant to prior radiofrequency ablation in 19 patients, rendering them non-inducible with no complications.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: