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Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: There is a limited knowledge of immediate and long-term efficacy of pulsed field ablation for residual atrial tachycardia (AT) following (longstanding) persistent atrial fibrillation (AF) ablation and resistant to prior radiofreque...

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Autores principales: Fiala, M, Cernosek, M, Bulkova, V, Bahnik, J, Lehar, F, Rybka, L, Manousek, J, Toman, O, Kala, P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207458/
http://dx.doi.org/10.1093/europace/euad122.754
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author Fiala, M
Cernosek, M
Bulkova, V
Bahnik, J
Lehar, F
Rybka, L
Manousek, J
Toman, O
Kala, P
author_facet Fiala, M
Cernosek, M
Bulkova, V
Bahnik, J
Lehar, F
Rybka, L
Manousek, J
Toman, O
Kala, P
author_sort Fiala, M
collection PubMed
description FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: There is a limited knowledge of immediate and long-term efficacy of pulsed field ablation for residual atrial tachycardia (AT) following (longstanding) persistent atrial fibrillation (AF) ablation and resistant to prior radiofrequency ablation (RFA). PURPOSE: To present immediate effects of PFA (Farapulse) in a series of patients with repeat ablation for residual atrial tachycardia (AT) resistant to prior RFA. METHODS AND RESULTS: In 5-11/2022, of 23 patients scheduled for PFA, 19 patients (64±7 years, 3 females) underwent PFA for left atrial (LA) AT resistant to RFA in first (n=4), second (n=11), third (n=3), and fourth (n=1) repeat ablation, respectively, after primary persistent AF ablation (4 patients were redirected to RFA for septal/right atrial AT source found by 3D mapping). At the procedure onset, persistent AT was ongoing (n=15) or was induced (n=4; AF induced and subsequently converted into AT in 3 patients). Mapping/ablation strategy was directed according to CS activation/entrainment to: 1) no 3D mapping and direct PFA (n=11); 2) PFA directly after 3D LA mapping (n=5); 3) PFA following RFA after 3D LA mapping (n=3). Total of 29 ATs was found (1,2, and 3 ATs in 12, 4, and 3 patients, respectively). Localized AT sources (n=16) dominated over macroreentry (MR) ATs (8 perimitral, 4 roof-dependent, 1 typical flutter). Only MR ATs, only localized ATs, and both MR+localized ATs were present in 7, 4, and 8 patients, respectively. All ATs were stopped with 5±9 PFA applications at the site of AT source and remained non-inducible. In 3 patients with initial ineffective RFA (6, 11, 6 minutes) within the same procedure, subsequent PFA terminated the AT with 1, 4, and 1 application respectively. Procedure and fluoroscopy times were 104±29 and 12±4 minutes, no complication occurred. CONCLUSION: PFA with catheter Farapulse can affect complex/epicardial AT sources resistant to RFA in prior or present ablation procedure.
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spelling pubmed-102074582023-05-25 Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy Fiala, M Cernosek, M Bulkova, V Bahnik, J Lehar, F Rybka, L Manousek, J Toman, O Kala, P Europace 9.4.4 - Catheter Ablation of Arrhythmias FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: There is a limited knowledge of immediate and long-term efficacy of pulsed field ablation for residual atrial tachycardia (AT) following (longstanding) persistent atrial fibrillation (AF) ablation and resistant to prior radiofrequency ablation (RFA). PURPOSE: To present immediate effects of PFA (Farapulse) in a series of patients with repeat ablation for residual atrial tachycardia (AT) resistant to prior RFA. METHODS AND RESULTS: In 5-11/2022, of 23 patients scheduled for PFA, 19 patients (64±7 years, 3 females) underwent PFA for left atrial (LA) AT resistant to RFA in first (n=4), second (n=11), third (n=3), and fourth (n=1) repeat ablation, respectively, after primary persistent AF ablation (4 patients were redirected to RFA for septal/right atrial AT source found by 3D mapping). At the procedure onset, persistent AT was ongoing (n=15) or was induced (n=4; AF induced and subsequently converted into AT in 3 patients). Mapping/ablation strategy was directed according to CS activation/entrainment to: 1) no 3D mapping and direct PFA (n=11); 2) PFA directly after 3D LA mapping (n=5); 3) PFA following RFA after 3D LA mapping (n=3). Total of 29 ATs was found (1,2, and 3 ATs in 12, 4, and 3 patients, respectively). Localized AT sources (n=16) dominated over macroreentry (MR) ATs (8 perimitral, 4 roof-dependent, 1 typical flutter). Only MR ATs, only localized ATs, and both MR+localized ATs were present in 7, 4, and 8 patients, respectively. All ATs were stopped with 5±9 PFA applications at the site of AT source and remained non-inducible. In 3 patients with initial ineffective RFA (6, 11, 6 minutes) within the same procedure, subsequent PFA terminated the AT with 1, 4, and 1 application respectively. Procedure and fluoroscopy times were 104±29 and 12±4 minutes, no complication occurred. CONCLUSION: PFA with catheter Farapulse can affect complex/epicardial AT sources resistant to RFA in prior or present ablation procedure. Oxford University Press 2023-05-24 /pmc/articles/PMC10207458/ http://dx.doi.org/10.1093/europace/euad122.754 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 9.4.4 - Catheter Ablation of Arrhythmias
Fiala, M
Cernosek, M
Bulkova, V
Bahnik, J
Lehar, F
Rybka, L
Manousek, J
Toman, O
Kala, P
Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
title Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
title_full Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
title_fullStr Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
title_full_unstemmed Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
title_short Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
title_sort pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
topic 9.4.4 - Catheter Ablation of Arrhythmias
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207458/
http://dx.doi.org/10.1093/europace/euad122.754
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