Extending Farapulse ablation to the posterior left atrial wall did not improve maintenance of sinus rhythm at 12 months compared to pulmonary vein isolation alone (82% vs 90%; p=0.156).
Cohort (n=171)
Does adding posterior left atrial wall ablation to pulmonary vein isolation using pulsed-field ablation reduce atrial arrhythmia recurrence in patients with persistent atrial fibrillation?
Extending pulsed-field ablation to include the posterior left atrial wall did not significantly reduce atrial arrhythmia recurrence at 1 year compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation.
Absolute Event Rate: 82% vs 90%
p-value: p=0.156
Abstract Introduction Pulsed-field ablation (PFA) represents an alternative energy source for atrial fibrillation (AF) ablation. Although pulmonary vein isolation (PVI) remains the cornerstone of ablation, the design of some PFA catheters allows for additional ablation of the posterior left atrial wall. The aim of this study was to assess the incidence of AF recurrence in patients with persistent AF depending on the ablation strategy used. Methods The study included 171 patients with persistent AF (M/F 130/41), with a mean age of 63 ± 8 years. Catheter ablation was performed using the Farapulse system under fluoroscopic guidance and with intracardiac echocardiography. The first group consisted of 22 patients who underwent PVI only; the second group included 149 patients whom additionally was posterior wall ablation performed. After the procedure, most patients discontinued antiarrhythmic drugs except for beta-blockers. Patients were followed at 3, 6, and 12 months after the procedure. A 24-hour Holter ECG was performed in 95% of patients (three times during the year), while 5% had a 7-day ECG recorder. Results Based on medical history, clinical status, and ECG monitoring, maintenance of sinus rhythm without recurrence of symptomatic atrial arrhythmia was observed in groups 1 vs. 2 at 3 months in 85% vs. 86%, at 6 months in 91% in both groups, and at 12 months in 90% vs. 82% of patients (p = 0.156). No major periprocedural complications were recorded. Fluoroscopy time did not differ between groups (11 vs. 13 minutes), but procedural time was significantly longer in the group with posterior wall ablation (65 vs. 72 minutes, p = 0.020). Conclusion In a one-year follow-up of patients with persistent AF, extending ablation to include posterior left atrial wall lines did not reduce atrial arrhythmia recurrence. No increase in periprocedural complications was observed. Further studies and longer follow-up are warranted to determine the optimal Farapulse ablation strategy in patients with persistent AF.
Misikova et al. (Mon,) conducted a cohort in Persistent atrial fibrillation (n=171). Pulmonary vein isolation plus posterior wall ablation vs. Pulmonary vein isolation only was evaluated on Maintenance of sinus rhythm without recurrence of symptomatic atrial arrhythmia at 12 months (p=0.156). Extending Farapulse ablation to the posterior left atrial wall did not improve maintenance of sinus rhythm at 12 months compared to pulmonary vein isolation alone (82% vs 90%; p=0.156).