Treatment of paroxysmal and persistent atrial fibrillation with pulsed field ablation

Figures

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  Figure 1. Safety profiles based on the proposed EHRA Complication Score. Based on the proposed EHRA complication score, safety indices derived from recent randomized controlled trials comparing pulsed-field ablation with thermal ablation confirm and quantitatively support the improved safety profile of PFA. Maximal safety would render a score of 100.

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  Figure 2. The ‘olive’ strategy workflow showing different pentaspline catheter configurations and applications. Durability data obtained from remapping studies using the ‘olive’ strategy.23

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  Figure 3. Posterior view of the left atrium in a PersAF patient after PWI performed with an Opal™ FaraNAV™ 31 mm (Boston Scientific, St Paul, MN, USA). (A) PFA lesion tags defining posterior wall boundaries. (B) Voltage map showing the posterior ‘box lesion’ type after PFA ablation.

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  Figure 4. PVI durability in first-in-human studies for different PFA systems. PVI durability per vein (blue) and per patient (green; proportion of patients with all PVs durably isolated) as assessed by invasive remapping ≥75 days after index ablation. For trials with concomitant workflow optimization, solid bars refer to the optimized workflow sub-cohort (AdmIRE trial for the Varipulse studies) and dashed white lines refer to the overall cohort (pooled population if multiple studies). Per patient, PVI durability is likely more clinically relevant but was not reported in all studies. Of note, the methodology differed between trials as indicated, particularly the remapping conditions (systematic, subset, or repeat ablation only; the latter typically enriches the population in PV reconnections). Other first-in-human studies did not report PVI durability data and are not included. PAF denotes paroxysmal atrial fibrillation; PerAF, persistent atrial fibrillation; PF, pulsed field; PVI, pulmonary vein isolation; RF, radiofrequency.

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  Figure 5. Correlation between healthcare utilization and arrhythmia burden. Healthcare utilization (HCU) as a function of atrial arrhythmia burden (A) and longest episode duration (B) assessed by implantable loop recorder 12 months after PFA for persistent AF in the ADVANTAGE AF Phase 2 trial. AA denotes atrial arrhythmia; AAD, antiarrhythmic drug; CV, cardiovascular visit; DCCV, direct current cardioversion. Reproduced with permission from Reddy et al.

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  Figure 6. Patient recovery timeline from procedure day to return to light activity/work and peak quality of life improvement following a PFA procedure, from discharge to return to self-care and light activity/work.

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  Figure 7. Integrated patient-reported outcome measures framework for PFA in AF leading to long-term patient value.