Abstract
Abstract
Background
A novel multipolar pulsed-field ablation (PFA) catheter has recently been introduced for pulmonary vein isolation (PVI). Pre-market data showed high rates for PVI-durability during mandatory remapping studies.
Objective: To present post-market data in patients with recurrent arrhythmias.
Methods
Consecutive patients undergoing a redo procedure after an index PFA PVI using a bipolar-biphasic PFA system were included. 3-D electro-anatomical maps (3D-EAM) on redo procedure were compared to the 3D-EAM acquired after ablation during the index procedure. PVI durability was assessed on a per-vein and per-patient level and the sites of reconnections were identified. Furthermore, lesion extent around veins with durable isolation was compared to study lesion regression.
Results
Of 341 patients treated with a PFA PVI, 29 (8.5%) underwent a left atrial redo ablation due to arrhythmia recurrence. At the end of the index procedure, 110/112 veins (98%, four common ostia) were isolated. On redo procedures performed a median of 6 months after the first ablation, 3D-EAM identified 69/110 (63%) PVs with durable isolation. In 6 (21%) patients, all PVs were durably isolated. Reconnections were more often found on the right-sided veins and on the anterior aspects of the upper veins. Only minor lesion regression was observed between the index and redo procedure (a median of 3 mm (0 – 9.5) on the posterior wall).
Conclusion
In patients with arrhythmia recurrence after PFA PVI using a first-generation PFA device, durable isolation was observed in 63% of the veins and 21% of the patients showed durable isolation of all previously isolated veins.
Graphical abstract
Publisher
Springer Science and Business Media LLC
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Reference22 articles.
1. Metzner A, Kuck KH, Chun JKR. What we have learned: is pulmonary vein isolation still the cornerstone of atrial fibrillation ablation? Europace. 2022;24:II8-13 (Oxford Academic).
2. He X, Chen Y, Zhou Y, Huang Y, He J. One-year clinical outcome of pulmonary vein isolation using the second-generation cryoballoon: a meta-analysis. Pacing Clin Electrophysiol. 2016;39:182–9 (Blackwell Publishing Inc.).
3. Cheung CC, Deyell MW, MacLe L, Verma A, Champagne J, Leong-Sit P, et al. Repeat atrial fibrillation ablation procedures in the CIRCA-DOSE study. Circ Arrhythm Electrophysiol. 2020;13:1033–5.
4. Ekanem E, Reddy VY, Schmidt B, Reichlin T, Neven K, Metzner A, et al. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). EP Europace. 2022;10:23 (Oxford University Press (OUP)).
5. Reddy VY, Neuzil P, Koruth JS, Petru J, Funosako M, Cochet H, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019;74:315–26 (Elsevier USA).
Cited by
9 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献