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Initial experience with pulsed field ablation for atrial fibrillation

INTRODUCTION: Pulsed field ablation (PFA) was recently introduced for the treatment of symptomatic atrial fibrillation (AF) with the claim of selectively ablating the myocardium while sparing surrounding tissues. We present our initial experience with a PFA catheter for pulmonary vein isolation (PVI...

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Autores principales: Magni, Federico T., Mulder, Bart A., Groenveld, Hessel F., Wiesfeld, Ans C. P., Tieleman, Robert G., Cox, Moniek G., Van Gelder, Isabelle C., Smilde, Tom, Tan, Eng S., Rienstra, Michiel, Blaauw, Yuri
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9679623/
https://www.ncbi.nlm.nih.gov/pubmed/36426226
http://dx.doi.org/10.3389/fcvm.2022.959186
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author Magni, Federico T.
Mulder, Bart A.
Groenveld, Hessel F.
Wiesfeld, Ans C. P.
Tieleman, Robert G.
Cox, Moniek G.
Van Gelder, Isabelle C.
Smilde, Tom
Tan, Eng S.
Rienstra, Michiel
Blaauw, Yuri
author_facet Magni, Federico T.
Mulder, Bart A.
Groenveld, Hessel F.
Wiesfeld, Ans C. P.
Tieleman, Robert G.
Cox, Moniek G.
Van Gelder, Isabelle C.
Smilde, Tom
Tan, Eng S.
Rienstra, Michiel
Blaauw, Yuri
author_sort Magni, Federico T.
collection PubMed
description INTRODUCTION: Pulsed field ablation (PFA) was recently introduced for the treatment of symptomatic atrial fibrillation (AF) with the claim of selectively ablating the myocardium while sparing surrounding tissues. We present our initial experience with a PFA catheter for pulmonary vein isolation (PVI) and describe procedural findings and peri-procedural safety of the first 100 patients. MATERIALS AND METHODS: We investigated 100 patients treated for symptomatic AF using the FARAWAVE PFA catheter (Farapulse, Menlo Park, CA, USA) between July 2021 and March 2022. Procedure workflow and electrophysiological findings at the time of ablation, peri-procedural complications, and operator learning curves are described. RESULTS: The mean age of patients was 62.9 ± 9.4 years, 62% were male subjects and 80% had paroxysmal AF. The median CHA(2)DS(2)-VASc score was 1.5 (IQR: 1.0–2.0) and the mean left atrial volume index was 35.7 ± 9.6 ml/m2. In 88 (88%) patients, PVI alone was performed and in 12 (12%) patients additional ablation of the posterior wall was performed. 3D-electroanatomic mapping was performed in 18 (18%) patients. Procedures without mapping lasted for 52.3 ± 16.6 min. The mean number of applications per pulmonary vein (PV) was 8.1 ± 0.6. In all patients (100%), all PVs were confirmed to be isolated. The learning curves of the two operators who performed > 20 procedures showed a negligible variation of performance over time and practice did not significantly predict procedure time [Operator 1 (senior): R(2) = 0.034, p = 0.35; Operator 2 (junior): R(2) = 0.004, p = 0.73]. There was no difference between the procedure times between senior and junior operators (Operator 1: 46.9 ± 9.7 min vs. Operator 2: 45.9 ± 9.9 min; p = 0.73). The only complications observed were two cases of bleeding at the site of percutaneous access. CONCLUSION: Our initial experience shows that use of the PFA catheter for pulmonary vein isolation (PVI) is safe, fast, and easy to learn.
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spelling pubmed-96796232022-11-23 Initial experience with pulsed field ablation for atrial fibrillation Magni, Federico T. Mulder, Bart A. Groenveld, Hessel F. Wiesfeld, Ans C. P. Tieleman, Robert G. Cox, Moniek G. Van Gelder, Isabelle C. Smilde, Tom Tan, Eng S. Rienstra, Michiel Blaauw, Yuri Front Cardiovasc Med Cardiovascular Medicine INTRODUCTION: Pulsed field ablation (PFA) was recently introduced for the treatment of symptomatic atrial fibrillation (AF) with the claim of selectively ablating the myocardium while sparing surrounding tissues. We present our initial experience with a PFA catheter for pulmonary vein isolation (PVI) and describe procedural findings and peri-procedural safety of the first 100 patients. MATERIALS AND METHODS: We investigated 100 patients treated for symptomatic AF using the FARAWAVE PFA catheter (Farapulse, Menlo Park, CA, USA) between July 2021 and March 2022. Procedure workflow and electrophysiological findings at the time of ablation, peri-procedural complications, and operator learning curves are described. RESULTS: The mean age of patients was 62.9 ± 9.4 years, 62% were male subjects and 80% had paroxysmal AF. The median CHA(2)DS(2)-VASc score was 1.5 (IQR: 1.0–2.0) and the mean left atrial volume index was 35.7 ± 9.6 ml/m2. In 88 (88%) patients, PVI alone was performed and in 12 (12%) patients additional ablation of the posterior wall was performed. 3D-electroanatomic mapping was performed in 18 (18%) patients. Procedures without mapping lasted for 52.3 ± 16.6 min. The mean number of applications per pulmonary vein (PV) was 8.1 ± 0.6. In all patients (100%), all PVs were confirmed to be isolated. The learning curves of the two operators who performed > 20 procedures showed a negligible variation of performance over time and practice did not significantly predict procedure time [Operator 1 (senior): R(2) = 0.034, p = 0.35; Operator 2 (junior): R(2) = 0.004, p = 0.73]. There was no difference between the procedure times between senior and junior operators (Operator 1: 46.9 ± 9.7 min vs. Operator 2: 45.9 ± 9.9 min; p = 0.73). The only complications observed were two cases of bleeding at the site of percutaneous access. CONCLUSION: Our initial experience shows that use of the PFA catheter for pulmonary vein isolation (PVI) is safe, fast, and easy to learn. Frontiers Media S.A. 2022-11-08 /pmc/articles/PMC9679623/ /pubmed/36426226 http://dx.doi.org/10.3389/fcvm.2022.959186 Text en Copyright © 2022 Magni, Mulder, Groenveld, Wiesfeld, Tieleman, Cox, Van Gelder, Smilde, Tan, Rienstra and Blaauw. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Magni, Federico T.
Mulder, Bart A.
Groenveld, Hessel F.
Wiesfeld, Ans C. P.
Tieleman, Robert G.
Cox, Moniek G.
Van Gelder, Isabelle C.
Smilde, Tom
Tan, Eng S.
Rienstra, Michiel
Blaauw, Yuri
Initial experience with pulsed field ablation for atrial fibrillation
title Initial experience with pulsed field ablation for atrial fibrillation
title_full Initial experience with pulsed field ablation for atrial fibrillation
title_fullStr Initial experience with pulsed field ablation for atrial fibrillation
title_full_unstemmed Initial experience with pulsed field ablation for atrial fibrillation
title_short Initial experience with pulsed field ablation for atrial fibrillation
title_sort initial experience with pulsed field ablation for atrial fibrillation
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9679623/
https://www.ncbi.nlm.nih.gov/pubmed/36426226
http://dx.doi.org/10.3389/fcvm.2022.959186
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