Pulsed field ablation of atrial fibrillation: recurrence rate after first pulmonary vein isolation and first insights into durability at redo procedures. (19th May 2022)

• Record Type: Journal Article
• Authors: Kueffer, T; Seiler, J; Madaffari, A; Muehl, A; Stettler, R; Asatryan, B; Haeberlin, A; Noti, F; Servatius, H; Tanner, H; Baldinger, SH; Roten, L; Reichlin, T
• Is Part Of: Europace. Volume 24:Supplement 1(2022)
• Publication Date: 2022-05-19
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac053.148
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Background: Pulsed field ablation (PFA) is newly available for pulmonary vein isolation (PVI) and combines the benefits of high procedural efficacy and safety. Independent data on the recurrence-rate of atrial fibrillation (AF) after PVI and on PVI durability during redo procedures are scarce. Purpose: We report data on the recurrence rate of AF after first PVI using PFA and first insights into findings of PVI durability during redo procedures. Methods: Consecutive AF patients undergoing a first PFA PVI at our center between May 2021 and August 2021 were included. PVI was verified by 3D-electroanatomical mapping (3D-EAM), and additional PFA lesions were applied when necessary until all PV were isolated. Seven-day Holter ECGs were performed at 3 and 6 months after ablation. After a blanking period of 3 months, episodes of AF/AT lasting more than 30 seconds were considered as AF-recurrence. Results: 41 Patients, median age 69 (interquartile range 62-73) years, 24% female, 56% persistent AF, underwent first PVI by PFA. All PVs were successfully isolated using a multipolar PFA catheter. Median total procedure time including 3D-EAM was 104 (85-121) min. Total fluoroscopy time and dose were 26 (19-30) min and 671 (323-1248) Gym2. Acute complications occurred in 1 (2.4%) patient (cardiac tamponade requiring drainage). Early recurrence of AF during the blanking period occurred in 1 (2.4%) patient. Median follow-up time was 107 (91-152) days. Recurrence of AF after the blanking period was detected in 5 (12%) patients, 1 (6%) in paroxysmal AF and 4 (17%) in persistent AF patients, respectively. Redo procedures in 3 (7.3%) patients with AF recurrence confirmed durable isolation of 12/12 (100%) pulmonary veins and showed no evidence of PFA lesion regression. Conclusion: AF recurrence rates after PVI by means of PFA are low. Durable isolation of 12/12 pulmonary veins (100%) and no evidence of PFA lesion regression was observed during redo procedures in patients with AF recurrence.