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Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation

Background: Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. Objective: Thi...

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Autores principales: Gunawardene, Melanie A., Frommeyer, Gerrit, Ellermann, Christian, Jularic, Mario, Leitz, Patrick, Hartmann, Jens, Lange, Philipp Sebastian, Anwar, Omar, Rath, Benjamin, Wahedi, Rahin, Eckardt, Lars, Willems, Stephan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573684/
https://www.ncbi.nlm.nih.gov/pubmed/37834948
http://dx.doi.org/10.3390/jcm12196304
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author Gunawardene, Melanie A.
Frommeyer, Gerrit
Ellermann, Christian
Jularic, Mario
Leitz, Patrick
Hartmann, Jens
Lange, Philipp Sebastian
Anwar, Omar
Rath, Benjamin
Wahedi, Rahin
Eckardt, Lars
Willems, Stephan
author_facet Gunawardene, Melanie A.
Frommeyer, Gerrit
Ellermann, Christian
Jularic, Mario
Leitz, Patrick
Hartmann, Jens
Lange, Philipp Sebastian
Anwar, Omar
Rath, Benjamin
Wahedi, Rahin
Eckardt, Lars
Willems, Stephan
author_sort Gunawardene, Melanie A.
collection PubMed
description Background: Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. Objective: This study aimed to investigate the efficacy and safety of LAPWI performed by non-thermal pulsed field ablation (PFA) in CA for persAF. Methods: Consecutive persAF patients from two German centers were prospectively enrolled. There were two study cohorts: (1) the LAPWI cohort, which included PFA-guided (re-)PVI with LAPWI for first-time and/or repeat ablation procedures; and (2) a comparative persAF cohort with a PFA PVI-only approach without LAPWI for first-time ablation within the same timeframe. Patients were followed up by routine Holter ECGs. Results: In total, 79 persistent AF patients were included in the study: 59/79 patients were enrolled in the LAPWI cohort, including 16/59 index (27%) and 43/59 repeat ablation procedures (73%). Sixteen patients (16/79; 21%) were in the PVI-only cohort without LAPWI. Of the patients treated with LAPWI, procedure time and fluoroscopy time was 91 ± 30 min and 15 ± 7 min, respectively. The acute PVI rate was 100% in all first-time ablation patients (32 patients (16 PVI only, 16 PVI plus LAPWI), 196/196 PVs). Of the 43 re-do patients in the LAPWI cohort, re-PVI was necessary in 33% (14/43) of patients (27 PVs; 1.9 PV per-patient); in 67% (29/43), all PVs were isolated, and antral ablation of the PV ostia was performed in 48% (14/29). LAPWI was performed successfully in all 59 (100%) patients of the LAPWI cohort. Two minor complications occurred. No esophageal lesion was detected in the LAPWI cohort (n = 33/59 (56%) patients underwent endoscopy). After 354 ± 197 days of follow-up, freedom from atrial arrhythmias was 79.3% (95-CI: 62–95%) in the complete LAPWI cohort (n = 14/59 (24%) on AAD: class Ic n = 9, class III n = 5). There was no difference regarding acute procedural and clinical outcome compared to the PVI-only cohort. Conclusion: LAPWI guided by PFA is feasible and safe in patients undergoing CA for persAF and shows favorable outcomes. In the context of durable PVI, PFA-guided LAPWI may be an effective adjunctive treatment option.
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spelling pubmed-105736842023-10-14 Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation Gunawardene, Melanie A. Frommeyer, Gerrit Ellermann, Christian Jularic, Mario Leitz, Patrick Hartmann, Jens Lange, Philipp Sebastian Anwar, Omar Rath, Benjamin Wahedi, Rahin Eckardt, Lars Willems, Stephan J Clin Med Article Background: Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. Objective: This study aimed to investigate the efficacy and safety of LAPWI performed by non-thermal pulsed field ablation (PFA) in CA for persAF. Methods: Consecutive persAF patients from two German centers were prospectively enrolled. There were two study cohorts: (1) the LAPWI cohort, which included PFA-guided (re-)PVI with LAPWI for first-time and/or repeat ablation procedures; and (2) a comparative persAF cohort with a PFA PVI-only approach without LAPWI for first-time ablation within the same timeframe. Patients were followed up by routine Holter ECGs. Results: In total, 79 persistent AF patients were included in the study: 59/79 patients were enrolled in the LAPWI cohort, including 16/59 index (27%) and 43/59 repeat ablation procedures (73%). Sixteen patients (16/79; 21%) were in the PVI-only cohort without LAPWI. Of the patients treated with LAPWI, procedure time and fluoroscopy time was 91 ± 30 min and 15 ± 7 min, respectively. The acute PVI rate was 100% in all first-time ablation patients (32 patients (16 PVI only, 16 PVI plus LAPWI), 196/196 PVs). Of the 43 re-do patients in the LAPWI cohort, re-PVI was necessary in 33% (14/43) of patients (27 PVs; 1.9 PV per-patient); in 67% (29/43), all PVs were isolated, and antral ablation of the PV ostia was performed in 48% (14/29). LAPWI was performed successfully in all 59 (100%) patients of the LAPWI cohort. Two minor complications occurred. No esophageal lesion was detected in the LAPWI cohort (n = 33/59 (56%) patients underwent endoscopy). After 354 ± 197 days of follow-up, freedom from atrial arrhythmias was 79.3% (95-CI: 62–95%) in the complete LAPWI cohort (n = 14/59 (24%) on AAD: class Ic n = 9, class III n = 5). There was no difference regarding acute procedural and clinical outcome compared to the PVI-only cohort. Conclusion: LAPWI guided by PFA is feasible and safe in patients undergoing CA for persAF and shows favorable outcomes. In the context of durable PVI, PFA-guided LAPWI may be an effective adjunctive treatment option. MDPI 2023-09-29 /pmc/articles/PMC10573684/ /pubmed/37834948 http://dx.doi.org/10.3390/jcm12196304 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gunawardene, Melanie A.
Frommeyer, Gerrit
Ellermann, Christian
Jularic, Mario
Leitz, Patrick
Hartmann, Jens
Lange, Philipp Sebastian
Anwar, Omar
Rath, Benjamin
Wahedi, Rahin
Eckardt, Lars
Willems, Stephan
Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation
title Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation
title_full Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation
title_fullStr Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation
title_full_unstemmed Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation
title_short Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation
title_sort left atrial posterior wall isolation with pulsed field ablation in persistent atrial fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573684/
https://www.ncbi.nlm.nih.gov/pubmed/37834948
http://dx.doi.org/10.3390/jcm12196304
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