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Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). A few small clinical studies and registries have reported an initial clinical success rate of...

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Autores principales: Neven, K, Fueting, A, Hartl, S, Reinsch, N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206949/
http://dx.doi.org/10.1093/europace/euad122.194
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author Neven, K
Fueting, A
Hartl, S
Reinsch, N
author_facet Neven, K
Fueting, A
Hartl, S
Reinsch, N
author_sort Neven, K
collection PubMed
description FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). A few small clinical studies and registries have reported an initial clinical success rate of approx. 80% after 1 year. Here, we present the results from re-do ablation after PVI using PFA for AF. METHODS: In symptomatic AF patients, re-do ablation in conscious sedation using a contact force sensing catheter and 45W RF energy was performed. In all patients, pre- and post-ablation high-density bipolar voltage 3D maps using a pentaspline diagnostic catheter were performed. Procedural parameters and acute success were assessed. RESULTS: Eighteen patients (age 67 years; 17% female; 56% PAF) from a total of 304 patients (age 67 years; 42% female; 47% PAF) (6%) treated with PFA as initial AF therapy underwent a re-do ablation 212 days after the index procedure. Mean CHA2DS2-VASc-score was 1,7 in the re-do group vs. 2,5 in the index procedure group. Mean duration since first AF diagnosis and BMI were not significantly different. In 12/18 (67%) patients, reconnection of at least 1 PV was found (LSPV 2x; LIPV 4x; RSPV 2x; RIPV 2x, left carina 4x; right carina 2x). All reconnected PVs were successfully reisolated. In 11/18 (61%) of patients, an atrial flutter (AFL) or tachycardia (AT) was identified (roof 5x; mitral isthmus 5x; anterior/septal 3x; cavotricuspid isthmus 5x). In 5/12 (42%) of patient with reconnection of at least 1 PV, AT/AFL occurred. In contrast, in all 6 patients (100%) with persistently isolated PVs AT/AFL occurred. All tachycardias were successfully ablated. CONCLUSIONS: Re-do ablation rate after PFA for AF was relatively low (6%), involving mostly male patients. PV reconnection rate was 67%, site of PV reconnection was predominantly left-sided. In 61%, predominantly left-sided AT/AFL occurred. Notably, in all patients with persistently isolated PVs AT/AFL was observed.
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spelling pubmed-102069492023-05-25 Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation Neven, K Fueting, A Hartl, S Reinsch, N Europace 10.4.5 - Rhythm Control, Catheter Ablation FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). A few small clinical studies and registries have reported an initial clinical success rate of approx. 80% after 1 year. Here, we present the results from re-do ablation after PVI using PFA for AF. METHODS: In symptomatic AF patients, re-do ablation in conscious sedation using a contact force sensing catheter and 45W RF energy was performed. In all patients, pre- and post-ablation high-density bipolar voltage 3D maps using a pentaspline diagnostic catheter were performed. Procedural parameters and acute success were assessed. RESULTS: Eighteen patients (age 67 years; 17% female; 56% PAF) from a total of 304 patients (age 67 years; 42% female; 47% PAF) (6%) treated with PFA as initial AF therapy underwent a re-do ablation 212 days after the index procedure. Mean CHA2DS2-VASc-score was 1,7 in the re-do group vs. 2,5 in the index procedure group. Mean duration since first AF diagnosis and BMI were not significantly different. In 12/18 (67%) patients, reconnection of at least 1 PV was found (LSPV 2x; LIPV 4x; RSPV 2x; RIPV 2x, left carina 4x; right carina 2x). All reconnected PVs were successfully reisolated. In 11/18 (61%) of patients, an atrial flutter (AFL) or tachycardia (AT) was identified (roof 5x; mitral isthmus 5x; anterior/septal 3x; cavotricuspid isthmus 5x). In 5/12 (42%) of patient with reconnection of at least 1 PV, AT/AFL occurred. In contrast, in all 6 patients (100%) with persistently isolated PVs AT/AFL occurred. All tachycardias were successfully ablated. CONCLUSIONS: Re-do ablation rate after PFA for AF was relatively low (6%), involving mostly male patients. PV reconnection rate was 67%, site of PV reconnection was predominantly left-sided. In 61%, predominantly left-sided AT/AFL occurred. Notably, in all patients with persistently isolated PVs AT/AFL was observed. Oxford University Press 2023-05-24 /pmc/articles/PMC10206949/ http://dx.doi.org/10.1093/europace/euad122.194 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle 10.4.5 - Rhythm Control, Catheter Ablation
Neven, K
Fueting, A
Hartl, S
Reinsch, N
Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
title Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
title_full Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
title_fullStr Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
title_full_unstemmed Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
title_short Re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
title_sort re-do ablation procedure characteristics after pulmonary vein isolation using pulsed field ablation for atrial fibrillation
topic 10.4.5 - Rhythm Control, Catheter Ablation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206949/
http://dx.doi.org/10.1093/europace/euad122.194
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