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La Fazia VM, Gianni C, Stifano G, Mohanty S, Chiricolo G, Burkhardt JD, Al-Ahmad A, Natale A. Extrapulmonary Vein Areas with Pulsed Field Ablation: Is the Transition Completed? Card Electrophysiol Clin 2025; 17:155-166. [PMID: 40412865 DOI: 10.1016/j.ccep.2025.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2025]
Abstract
Pulsed field ablation (PFA) is an innovative technology for the ablation of atrial fibrillation (AF), characterized by its ability to create tissue-selective lesions while minimizing collateral damage to surrounding structures. Isolation of the pulmonary veins (PVs) remains the cornerstone of AF ablation; however, recent evidence underscores the significance of extra-PV triggers, such as those from the posterior wall of the left atrium, the superior vena cava, the coronary sinus, and the left atrial appendage. While preliminary data suggest that PFA may enhance safety outcomes compared to traditional thermal techniques, further studies needed to validate its efficacy in non-PV areas.
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Affiliation(s)
- Vincenzo Mirco La Fazia
- Department of Clinical Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North Interstate Highway 35 Suite 700, Austin, TX 78705, USA
| | - Carola Gianni
- Department of Clinical Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North Interstate Highway 35 Suite 700, Austin, TX 78705, USA
| | - Giuseppe Stifano
- Division of Cardiology, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Roma 00133, Italy
| | - Sanghamitra Mohanty
- Department of Clinical Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North Interstate Highway 35 Suite 700, Austin, TX 78705, USA
| | - Gaetano Chiricolo
- Division of Cardiology, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Roma 00133, Italy
| | - J David Burkhardt
- Department of Clinical Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North Interstate Highway 35 Suite 700, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Department of Clinical Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North Interstate Highway 35 Suite 700, Austin, TX 78705, USA
| | - Andrea Natale
- Division of Cardiology, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Roma 00133, Italy; Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North Interstate Highway 35 Suite 700, Austin, TX 78705, USA.
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2
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Reddy VY, Gerstenfeld EP, Schmidt B, Nair D, Natale A, Saliba W, Verma A, Sommer P, Metzner A, Turagam M, Weiner S, Champagne J, Garcio-Bolao I, Calkins H, Olson J, Issa Z, Winner M, Su W, Tomassoni G, Kim J, Hook B, Delurgio DB, Gibson DN, Daccarett M, Patel C, Bhalla K, Shehata M, Harding JD, Cheung JW, Raybuck JD, Roelke S, Schwartz T, Sutton BS, Mansour M. Pulsed Field Ablation for Persistent Atrial Fibrillation: 1-Year Results of ADVANTAGE AF. J Am Coll Cardiol 2025; 85:1664-1678. [PMID: 40306839 DOI: 10.1016/j.jacc.2025.03.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 03/05/2025] [Accepted: 03/12/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND Pulsed field ablation (PFA) has gained prominence for pulmonary vein isolation (PVI) to treat atrial fibrillation, but there are limited outcome data on PFA to treat persistent atrial fibrillation (PerAF). OBJECTIVES This study sought to determine the safety and efficacy of PVI + posterior wall ablation (PWA) with PFA in PerAF. METHODS ADVANTAGE AF (A Prospective Single Arm Open Label Study of the FARAPULSE Pulsed Field Ablation System in Subjects with Persistent Atrial Fibrillation) is a prospective, single-arm, multicenter pivotal investigational device exemption study of PerAF patients undergoing PVI+PWA with the pentaspline PFA catheter. One-year follow-up included 24-hour Holter monitoring at 6 and 12 months and twice monthly and symptomatic transtelephonic monitoring. The primary safety endpoint was incidence of predefined adverse events. The primary effectiveness endpoint included acute success and postblanking 1-year freedom from atrial tachyarrhythmia recurrence (>30 seconds), redo ablation, cardioversion, or antiarrhythmic drug escalation. Endpoint analysis used Kaplan-Meier methodology with 97.5% 1-sided confidence limits compared with a 12% safety and 40% effectiveness goals, with 85% power. RESULTS PFA in 339 patients (260 treatment and 79 roll-in) resulted in 99.7% success for both PVI and PWA. The primary safety endpoint was 2.3% (5.1% upper confidence limit), including 1 with pericarditis, 1 with myocardial infarction, and 4 with pulmonary edema; no tamponade, stroke, pulmonary vein stenosis, or esophageal fistula occurred. Primary effectiveness was 63.5% (57.3% lower confidence limit) at 1 year, with 8.5% patients having a single, isolated atrial fibrillation recurrence. Freedom from symptomatic atrial fibrillation was 85.3%; efficacy varied by operator experience. CONCLUSIONS ADVANTAGE AF, the first large prospective study of PFA to treat PerAF using a strategy of PVI and posterior wall isolation, revealed favorable safety and effectiveness outcomes. (A Prospective Single Arm Open Label Study of the FARAPULSE Pulsed Field Ablation System in Subjects with Persistent Atrial Fibrillation [ADVANTAGE AF]; NCT05443594).
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Affiliation(s)
- Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, New York, USA.
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Devi Nair
- St Bernards Medical Center and Arrhythmia Research Group, Jonesboro, Arkansas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Research, Austin, Texas, USA; Case Western Reserve University, Cleveland, Ohio, USA; Division of Cardiology, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Walid Saliba
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Atul Verma
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Philipp Sommer
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany; Ruhr-University Bochum, Germany
| | | | | | - Stanislav Weiner
- Christus Trinity Mother Frances Health System, Tyler, Texas, USA
| | - Jean Champagne
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
| | | | - Hugh Calkins
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Ziad Issa
- St John's Hospital, Springfield, Illinois, USA
| | | | - Wilber Su
- Banner-University Medical Center Phoenix, Phoenix, Arizona, USA
| | | | - Jamie Kim
- Catholic Medical Center, Manchester, New Hampshire, USA
| | - Bruce Hook
- Lahey Clinic Hospital, Burlington, Massachusetts, USA
| | | | | | | | - Chinmay Patel
- Pinnacle Health at Harrisburg Hospital, Wormleysburg, Pennsylvania, USA
| | | | | | | | | | | | | | | | - Brad S Sutton
- Boston Scientific Corporation, St Paul, Minnesota, USA
| | - Moussa Mansour
- Massachusetts General Hospital, Boston, Massachusetts, USA
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3
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Kaddoura R, Abushanab D, Asaad N. Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: a systematic review and meta-analysis. Postgrad Med J 2025:qgaf049. [PMID: 40197795 DOI: 10.1093/postmj/qgaf049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 02/08/2025] [Accepted: 02/15/2025] [Indexed: 04/10/2025]
Abstract
This review investigated efficacy and safety of pulsed-field ablation (PFA) in comparison with radiofrequency ablation (RFA), cryoballoon ablation (CBA), or both combined. The Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed. PFA allowed shorter procedure (MD -44.27 minutes, 95% CI: -63.61; -24.93) and left atrium (LA) dwell (MD -32.71 minutes (95% CI: -58.64; -6.78) times, but with longer fluoroscopy time than RFA (MD 8.54 minutes, 95% CI: 4.03; 13.04). Post-procedural complications rate was lower with PFA than CBA (OR 0.53, 95% CI: 0.35, 0.80). Atrial arrhythmias recurrence rate within one year of follow-up was lower with PFA than RFA (OR 0.68, 95% CI; 0.53; 0.87) and CBA (OR 0.69, 95% CI: 0.48; 0.97). PFA allowed shorter procedure and LA dwell times, as well as lower atrial arrhythmia recurrence than RFA and lower post-procedural complications and atrial arrhythmias recurrence rates than CBA.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Drug Information Center, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Asaad
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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4
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Schiavone M, Di Biase L. A new basket player on the court: pulsed field ablation with a balloon-in-basket system for atrial fibrillation. Europace 2025; 27:euaf065. [PMID: 40163667 PMCID: PMC12036653 DOI: 10.1093/europace/euaf065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Accepted: 03/20/2025] [Indexed: 04/02/2025] Open
Affiliation(s)
- Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, 111 East 210 Street, Bronx, NY 10467, USA
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5
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Abeln BGS, Addeo L, De Potter T, Boersma LVA. Durability of Ultra-Low Temperature Cryoablation Lesions in Atrial Fibrillation: Insights From Repeat Ablation Procedures. J Cardiovasc Electrophysiol 2025. [PMID: 40150915 DOI: 10.1111/jce.16665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 03/04/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND Ultra-low temperature cryoablation (ULTC) is a technique designed to rapidly cool cardiac tissue to extremely low temperatures, enabling the creation of ablation lesions for the treatment of atrial fibrillation (AF). Prior studies have demonstrated low rates of arrhythmia recurrence, but little is known about ablation lesion durability. METHODS Patients undergoing repeat ablation were selected from the CryoCure2 (NCT02839304) and iCLAS PMCF(NCT05416086) studies. Baseline patient and ULTC procedure characteristics were evaluated. During repeat ablation, ULTC ablation lesions were assessed for electrical block, including segment-based assessment of pulmonary vein (PV) ablation lesions. Arrhythmia outcomes after repeat ablation were evaluated. RESULTS Twenty-five patients were included in the cohort: Age 68 ± 7 years, male 68%, persistent AF 68%, LAVI 42 ± 24 mL/m2. During index procedure, ULTC was used to target the PVs in all patients, the left atrium posterior wall (LAPW) in 15 patients, the lateral mitral isthmus (LMI) in five patients and the cavotricuspid isthmus (CTI) in two patients. At repeat ablation, PV reconnection was observed in 21/25 patients (55/100 PVs reconnected), and reconnection occurred most often in the anterior segments of the left PVs. The LAPW lesion was incomplete in 4/15 patients, the LMI in 3/5 and the CTI in 1/2. After repeat ablation, 10/25 patients had arrhythmia recurrence. CONCLUSION Reconnection of ablation targets during repeat ablation for arrhythmia recurrence following ULTC occurred at rates comparable to those observed with conventional thermal ablation modalities. The anterior side of the left PVs appears to be reconnected most often.
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Affiliation(s)
- Bob G S Abeln
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Lucio Addeo
- Department of Cardiology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Tom De Potter
- Department of Cardiology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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6
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Lustig P, Lee J, Sponder M, Stix G, Hengstenberg C, Schönbauer R, Stojkovic S. Left Atrial Substrate Modification for Long-Standing Persistent Atrial Fibrillation and Left Atrial Macro- or Micro-Reentrant Tachycardia Using a Single-Shot Pulsed Field Ablation System-A Case Series. J Clin Med 2025; 14:1891. [PMID: 40142699 PMCID: PMC11943349 DOI: 10.3390/jcm14061891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/07/2025] [Accepted: 03/08/2025] [Indexed: 03/28/2025] Open
Abstract
Background: Pulsed field ablation [PFA] is a novel ablation technique for pulmonary vein isolation [PVI] in patients with paroxysmal and persistent atrial fibrillation. However, data for the efficacy and safety of PFA for left atrial substrate modification using a single shot PFA system, in patients with long-standing persistent atrial fibrillation [AF] and left atrial macro- as well as micro-reentrant atrial tachycardia [LAMRT], are scarce. Here, we provide a small, single-center case series regarding the efficacy and safety of left atrial substrate modification using a single-shot PFA system. Methods: Nine patients with long-standing persistent AF and LAMRT underwent redo-PVI and left atrial substrate modification using a single-shot PFA system. Patients were subsequently followed up for 1 year. Results: The median age was 64 years [IQR 55.5-75], with 44% of the participants being female. The median time since the first diagnosis of AF was 7 years [IQR 4-15.5]. After re-PVI, posterior wall isolation was performed in five patients, roof isolation in six patients, and anterior wall ablation between the superior mitral annulus and the right superior pulmonary vein [RSPV] in five patients. In two patients, cavotricuspid isthmus ablation was additionally performed to treat typical atrial flutter. The acute procedural success rate was 100%, with all LAMRTs and typical flutters successfully terminating by ablation. At 1-year follow-up, four patients [44%] experienced a recurrence of any atrial arrhythmia. Median time to recurrence was 164 days [138-212.8]. Importantly, no acute or chronic complications were observed. Conclusions: In this small, single-center case series, left atrial substrate modification for long-standing persistent AF and AT using a single-shot PFA system was safe and showed an excellent acute success rate.
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Affiliation(s)
| | | | | | | | | | | | - Stefan Stojkovic
- University Clinic for Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (P.L.); (J.L.); (M.S.); (G.S.); (C.H.); (R.S.)
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Peruzza F, Candelora A, Angheben C, Maines M, Laurente M, Catanzariti D, Del Greco M, Madaffari A. Catheter Ablation of Atrial Fibrillation: Technique and Future Perspectives. J Clin Med 2025; 14:1788. [PMID: 40142600 PMCID: PMC11943125 DOI: 10.3390/jcm14061788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Revised: 02/24/2025] [Accepted: 03/04/2025] [Indexed: 03/28/2025] Open
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia with a significant impact on quality of life in terms of symptoms and reduction of functional status. Also, it is associated with an increased risk of mortality, stroke, and peripheral embolism. Catheter ablation for atrial fibrillation has become a well-established treatment, improving arrhythmia outcomes without increasing the risk of serious adverse events compared to antiarrhythmic drug therapy. The field has undergone significant advancements in recent years, yet pulmonary vein isolation continues to be the cornerstone of any atrial fibrillation ablation procedure. The purpose of this review is to provide an overview of the current techniques, emerging technologies, and future directions.
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Affiliation(s)
- Francesco Peruzza
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
| | - Andrea Candelora
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
| | - Carlo Angheben
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
| | - Massimiliano Maines
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
| | - Mauro Laurente
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
| | - Domenico Catanzariti
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
| | - Maurizio Del Greco
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
| | - Antonio Madaffari
- Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy; (F.P.); (M.M.); (M.L.); (M.D.G.)
- Azienda Provinciale per i Servizi Socio Sanitari–APSS, 38123 Trento, Italy
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8
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Casula M, Scajola LV, Quilico F, Pasotti B, Cesarano E, Sanzo A, Savastano S, Rordorf R. Posterior left atrial wall isolation for treatment of persistent atrial fibrillation during first-time catheter ablation: An updated systematic review and meta-analysis. Int J Cardiol 2025; 422:132987. [PMID: 39809414 DOI: 10.1016/j.ijcard.2025.132987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/21/2024] [Accepted: 01/10/2025] [Indexed: 01/16/2025]
Abstract
BACKGROUND Although catheter ablation (CA) by mean of pulmonary vein isolation (PVI) is nowadays the mainstay treatment for atrial fibrillation (AF), its success-rate in persistent AF remains suboptimal. Results from studies evaluating whether adding posterior wall isolation (PWI) to PVI can increase the success-rate of CA in persistent AF have yielded conflicting data. The aim of this meta-analysis was to assess whether PWI plus PVI might be beneficial in patients with persistent AF. METHODS Electronic databases were searched for randomized control trials (RCTs) and observational studies that compared clinical outcomes between patients with persistent AF who underwent PVI with or without PWI. RESULTS Fifteen studies, including a total of 3072 patients, were considered (1533 treated with PVI and 1539 with PWI + PVI). Comparing patients treated with or without PWI, no statistically significant difference was found in the risk of any atrial tachyarrhythmias recurrence after CA (RR 0.83; 95 % CI 0.66-1.03). The analyses detected a statistically significant reduction in the risk of AF in patients treated with PWI (RR 0.63; 95 % CI 0.48-0.84) balanced by a trend towards an increased risk of atrial flutter/atrial tachycardia (RR 1.51; 95 % CI 0.92-2.49). No statistically significant differences were identified in the risk of major procedural complications (RR 0.94; 95 % CI 0.50-1.78). CONCLUSIONS According to our updated meta-analysis, the addition of PWI to PVI was not associated with a reduction of atrial arrhythmia recurrences. A reduction of the risk of AF recurrence and a trend towards an increased risk of atrial flutter/atrial tachycardia were identified.
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Affiliation(s)
- Matteo Casula
- Cardiology and Cardiovascular Intensive Care Unit, ARNAS "G. Brotzu", Cagliari, Italy
| | - Luca Vicini Scajola
- Department of Molecular Medicine, University of Pavia, Italy; Arrhythmias and Electrophysiology Unit, Division of Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Federico Quilico
- Department of Molecular Medicine, University of Pavia, Italy; Arrhythmias and Electrophysiology Unit, Division of Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | | | - Elisa Cesarano
- Cardiology and Cardiovascular Intensive Care Unit, ARNAS "G. Brotzu", Cagliari, Italy
| | - Antonio Sanzo
- Arrhythmias and Electrophysiology Unit, Division of Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Simone Savastano
- Arrhythmias and Electrophysiology Unit, Division of Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Roberto Rordorf
- Arrhythmias and Electrophysiology Unit, Division of Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
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Reinsch N, Johnson V, Rolf S, Busch S, Ebert M, Maurer T, Tilz R, Althoff T, Chun J, Duncker D, Heeger C, Jansen H, Iden L, Rillig A, Sommer P, Dahme T, Gunawardene M, Estner HL, Steven D. [Guideline to safe and effective atrial fibrillation ablation with pulsed-field ablation using the pentaspline PFA system as an example]. Herzschrittmacherther Elektrophysiol 2025:10.1007/s00399-025-01071-z. [PMID: 40019534 DOI: 10.1007/s00399-025-01071-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 01/16/2025] [Indexed: 03/01/2025]
Abstract
Atrial fibrillation ablation is an established procedure for the treatment of atrial fibrillation, in which Pulsed Field Ablation (PFA) is a novel method alongside radiofrequency and cryoablation. The article explains the technical basics of PFA, describes different types of catheters and gives detailed instructions on how to perform the procedure, from patient selection to sedation strategies and imaging. Important safety aspects and possible complications are also covered. Finally, the further development of PFA technology for the treatment of other arrhythmias and integration into 3D mapping systems is discussed. This work is part of a series of articles on further training in special rhythmology.
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Affiliation(s)
- Nico Reinsch
- Abteilung für Elektrophysiologie, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131, Essen, Deutschland.
- Universität Witten/Herdecke, Witten, Deutschland.
| | - Victoria Johnson
- Universitäres Herz- und Gefäßzentrum, ZIM III Kardiologie und Angiologie, Frankfurt, Deutschland
| | - Sascha Rolf
- Klinik für Innere Medizin - Kardiologie, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - Sonia Busch
- Abteilung Elektrophysiologie, Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Micaela Ebert
- Sektion Rhythmologie, Klinik für Innere Medizin und Kardiologie, Herzzentrum Dresden, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Tilmann Maurer
- CardioMed Hamburg, Hamburg, Deutschland
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Hamburg, Deutschland
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik Nord, Hamburg, Deutschland
| | - Roland Tilz
- Abteilung für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Deutschland
| | - Till Althoff
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC - Barcelona University Hospital, Barcelona, Spanien
| | - Julian Chun
- CCB Frankfurt, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Heeger
- Abteilung für Rhythmologie, Klinik für Kardiologie und Innere Medizin, Asklepios Klinik Hamburg Altona, Hamburg, Deutschland
| | | | - Leon Iden
- Herz- und Gefäßzentrum der Segeberger Kliniken GmbH, Bad Segeberg, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Philipp Sommer
- Klinik für Rhythmologie und Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Uni Bochum, Medizinische Fakultät der Uni Bielefeld, Bad Oeynhausen, Deutschland
| | - Tillman Dahme
- Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Esslingen, Esslingen, Deutschland
| | - Melanie Gunawardene
- Kardiologie und Internistische Intensivmedizin, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
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10
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Camanho LEM. Does Posterior Wall Isolation in Catheter Ablation of Persistent Atrial Fibrillation Change Clinical Outcomes? Arq Bras Cardiol 2025; 122:e20240815. [PMID: 39968973 PMCID: PMC11870122 DOI: 10.36660/abc.20240815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 12/10/2024] [Accepted: 12/10/2024] [Indexed: 02/20/2025] Open
Affiliation(s)
- Luiz Eduardo Montenegro Camanho
- Hospital Pró-CardíacoServiço de Arritmia Invasiva e Estimulação Cardíaca ArtificialRio de JaneiroRJBrasilHospital Pró-Cardíaco – Serviço de Arritmia Invasiva e Estimulação Cardíaca Artificial – Centro de Fibrilação Atrial, Rio de Janeiro, RJ – Brasil
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Gribissa S, Kueffer T, Knecht S, Waintraub X, Badenco N, Charron P, Pinon P, King R, Gandjbakhch E, Duthoit G, Sticherling C, Reichlin T, Laredo M. Pulsed-Field vs Thermal Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. JACC Clin Electrophysiol 2025:S2405-500X(25)00065-9. [PMID: 40088215 DOI: 10.1016/j.jacep.2025.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 01/15/2025] [Accepted: 01/21/2025] [Indexed: 03/17/2025]
Abstract
BACKGROUND Pulsed-field ablation (PFA) may be beneficial for the treatment of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). OBJECTIVES The goal of this study was to compare the safety and efficacy of PFA and thermal ablation in patients with HCM and AF. METHODS From 2016 to 2024, patients with HCM undergoing a first AF ablation using PFA or thermal ablation (cryoballoon or radiofrequency) were retrospectively included from 3 French and Swiss centers. Freedom from atrial arrhythmia (AA) recurrence at the 12-month follow-up was assessed. RESULTS Overall, 109 patients (median age 60 years; 68% male; 43% paroxysmal AF) with HCM underwent PFA (n = 58) or thermal ablation (n = 51) of AF. In addition to pulmonary vein (PV) isolation, extra-PV ablation was performed in 62% of PFA cases and in 18% of thermal cases. PFA was associated with shorter median procedure times than thermal ablation (81 minutes [Q1-Q3: 60-110 minutes] vs 132 minutes [Q1-Q3: 75-190 minutes]; P < 0.0001) and with less postprocedural heart failure (n = 0 vs n = 4; P = 0.03). Freedom from AA recurrence was 57% (95% CI: 46%-67%) after 12 months. PFA was associated with less AA recurrence than thermal ablation (adjusted HR: 0.46; 95% CI: 0.23-0.91; P = 0.03). Extra-PV ablation was associated with more sustained AA recurrence with thermal ablation (HR: 3.07; 95% CI: 1.21-7.82; P = 0.02) but not with PFA (HR: 1.07; 95% CI: 0.35-3.27; P = 0.91). CONCLUSIONS In patients with HCM and AF, PFA seems to be associated with better safety and efficacy outcomes than thermal ablation.
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Affiliation(s)
- Samy Gribissa
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Xavier Waintraub
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Nicolas Badenco
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Philippe Charron
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France; Département de Génétique, Centre de Références des Maladies Cardiaques Héréditaires ou rares, Sorbonne Université, AP-HP, Inserm UMR_1166, IHU ICAN, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Pauline Pinon
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Raphael King
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Estelle Gandjbakhch
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France; Département de Génétique, Centre de Références des Maladies Cardiaques Héréditaires ou rares, Sorbonne Université, AP-HP, Inserm UMR_1166, IHU ICAN, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Guillaume Duthoit
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | | | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mikael Laredo
- Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France.
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12
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Isenegger C, Krisai P, Knecht S, Katic J, Schaerli N, Voellmin G, Mahfoud F, Sticherling C, Kühne M, Badertscher P. Posterior wall isolation with pulsed field ablation or radiofrequency ablation with vein of Marshall ethanol ablation for repeat catheter ablation of recurrent atrial fibrillation. J Interv Card Electrophysiol 2025:10.1007/s10840-025-01991-3. [PMID: 39907944 DOI: 10.1007/s10840-025-01991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 01/09/2025] [Indexed: 02/06/2025]
Affiliation(s)
- Corinne Isenegger
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Josip Katic
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Split, Croatia
| | - Nicolas Schaerli
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Felix Mahfoud
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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13
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Schiavone M, Tondo C. Pulsed field ablation in atrial fibrillation ablation: where are we and where are we going? Eur Heart J Suppl 2025; 27:i167-i170. [PMID: 39980779 PMCID: PMC11836714 DOI: 10.1093/eurheartjsupp/suae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2025]
Abstract
Pulsed field ablation (PFA) offers a novel approach to treating atrial fibrillation, demonstrating promising efficacy and safety. Unlike traditional thermal ablation techniques like radiofrequency or cryoablation, PFA uses non-thermal irreversible electroporation to selectively target myocardial tissue, minimizing damage to surrounding structures such as the oesophagus, phrenic nerve, and coronary arteries. Initial studies indicate that PFA is effective in achieving durable pulmonary vein isolation and posterior wall isolation, with a low incidence of serious complications. However, more long-term clinical data are needed to further confirm its efficacy.
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Affiliation(s)
- Marco Schiavone
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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14
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Kuroki K, Tada H. Catheter ablation using pulsed-field energy: Advantages and limitations compared with conventional energy. J Arrhythm 2025; 41:e70011. [PMID: 39906095 PMCID: PMC11792576 DOI: 10.1002/joa3.70011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 12/29/2024] [Accepted: 01/19/2025] [Indexed: 02/06/2025] Open
Abstract
Atrial fibrillation (AF) poses significant risks of heart failure and stroke, emphasizing effective treatment. Catheter ablation using thermal energy sources, such as radiofrequency or cryoballoon ablation, has shown greater success in maintaining sinus rhythm compared with drug therapy. However, thermal ablation (TA) is associated with serious complications, such as atrial-esophageal fistula, phrenic nerve palsy, and pulmonary vein stenosis. Pulsed-field ablation (PFA) is an emerging ablation energy source that uses electroporation to selectively target cardiac tissue while sparing adjacent structures such as nerves and blood vessels. Two randomized controlled trials have demonstrated that PFA is comparable to TA in both efficacy and safety at a 1-year follow-up and had shorter procedure times. A review of six meta-analyses consistently showed shorter procedural times for PFA across all studies. Additionally, three out of the four recent studies with large samples reported lower recurrence rates with PFA. Regarding complication rates, four out of four studies showed lower incidences of phrenic nerve injury with PFA, and two out of three studies reported lower rates of esophageal injury with PFA. However, four out of four studies indicated higher incidences of cardiac tamponade with PFA, highlighting the need for caution among early-career operators. Furthermore, careful monitoring is required considering the possible unforeseen complications specific to PFA and the lack of long-term follow-up data. Despite these concerns, PFA shows promise as a safer, more effective, and efficient alternative to TA for AF, particularly as operator experience and device technology continue to advance.
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Affiliation(s)
- Kenji Kuroki
- Department of Cardiology, Faculty of MedicineUniversity of YamanashiYamanashiJapan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
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15
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Farnir F, Chaldoupi SM, Hermans BJM, Farnir F, Habibi Z, Jerltorp K, Verhaert D, Schotten U, Maesen B, Vernooy K, Luermans J, Linz D. A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates. Heart Rhythm 2025:S1547-5271(25)00084-0. [PMID: 39828072 DOI: 10.1016/j.hrthm.2025.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 12/11/2024] [Accepted: 01/09/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF). OBJECTIVE We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate. METHODS Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force-sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated. RESULTS In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m2; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl). CONCLUSION Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.
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Affiliation(s)
- Florent Farnir
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ben J M Hermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frédéric Farnir
- Department of Biostatistics and Bioinformatics, FARAH, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
| | - Zarina Habibi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kezia Jerltorp
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Verhaert
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bart Maesen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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16
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Marek J, Stojadinović P, Wichterle D, Peichl P, Hašková J, Borišincová E, Štiavnický P, Čihák R, Šramko M, Kautzner J. Atrial Fibrillation Ablation During Hospitalization for Acute Heart Failure: Feasibility and Role of Pulsed Field Ablation. J Cardiovasc Electrophysiol 2025; 36:256-265. [PMID: 39588593 PMCID: PMC11727001 DOI: 10.1111/jce.16507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/06/2024] [Accepted: 11/09/2024] [Indexed: 11/27/2024]
Abstract
INTRODUCTION Atrial fibrillation (AF) can cause or aggravate heart failure (HF). Catheter ablation (CA) is an effective treatment for AF. This study focused on the feasibility and outcomes of emergent AF ablation performed during hospitalization for acute HF. METHODS AND RESULTS We retrospectively investigated patients who underwent emergent CA for AF during hospitalization for acute HF in 2018-2024. Arrhythmia recurrence was the primary endpoint. The combination of arrhythmia recurrence, HF hospitalization, and all-cause death was the secondary endpoint. Patients were censored 1 year after the index procedure. We included 46 patients, 35% females, with median age of 67 [interquartile rage: 61, 72] years and left ventricular ejection fraction (LVEF) of 25 [23, 28]%. Thermal CA was performed in 14 patients, and pulsed field ablation (PFA) in 32 patients. Procedure time was significantly shorter with PFA compared to thermal CA (77 [57, 91] vs. 166 [142, 200] minutes, p < 0.001). Fluoroscopy time was longer with PFA (9.5 [7.6, 12.0] vs. 3.9 [2.9, 6.0] minutes, p < 0.001), with a borderline trend towards higher radiation dose (75 [53, 170] vs. 50 [30, 94] μGy.m2, p = 0.056). Extrapulmonary ablation was frequent (86% and 84% for thermal CA and PFA, p > 0.9). The estimated freedom from the primary endpoint was 79% after PFA and 64% after thermal CA (p = 0.44). The estimated freedom from the secondary endpoint was 76% after PFA and 57% after thermal CA (p = 0.43). LVEF improved by 24% ± 2% (p < 0.001) in patients with the first manifestation of HF and by 14% ± 4% (p = .004) in patients with decompensated HF diagnosed earlier. CONCLUSIONS Emergent CA of AF during acute HF hospitalization is safe and associated with improved LVEF and good clinical outcomes. In the PFA era, the rate of these procedures is progressively increasing as they are readily available and easy to perform compared to thermal ablation.
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Affiliation(s)
- Josef Marek
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
- 2nd Department of Medicine – Department of Cardiovascular MedicineCharles University Medical School IPragueCzechia
| | - Predrag Stojadinović
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
| | - Dan Wichterle
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
- 2nd Department of Medicine – Department of Cardiovascular MedicineCharles University Medical School IPragueCzechia
| | - Petr Peichl
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
| | - Jana Hašková
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
| | - Eva Borišincová
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
| | - Petr Štiavnický
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
| | - Robert Čihák
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
| | - Marek Šramko
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
| | - Josef Kautzner
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzechia
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17
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Mills MT, Trivedi S, Lovell MJ, Murgatroyd F, Calvert P, Luther V, Gupta D, Martin C, Zeriouh S, Mellor G, Balasubramaniam R, Sopher M, Boullin J, Arujuna A, Chalil S, Gall S, Chen Z, Saba M, Buckley U, Somani R, Chin SH, Jones D, Kaba RA, O'Neill M, Wong T, Todd DM. Pulsed-field ablation of atrial fibrillation with a pentaspline catheter across National Health Service England centres. Open Heart 2024; 11:e003094. [PMID: 39694575 PMCID: PMC11667399 DOI: 10.1136/openhrt-2024-003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 12/02/2024] [Indexed: 12/20/2024] Open
Abstract
INTRODUCTION Pulsed-field ablation (PFA) is a novel modality for pulmonary vein isolation in patients with atrial fibrillation (AF). We describe the initial uptake and experience of PFA using a pentaspline catheter across selected National Health Service England (NHSE) centres. METHODS Data collected by NHSE Specialised Services Development Programme regarding AF ablation procedures using a single-shot, pentaspline, multielectrode PFA catheter (FARAWAVE, Boston Scientific) between June 2022 and August 2024 were aggregated and analysed to examine procedural metrics, acute efficacy and safety outcomes over 3-month follow-up. RESULTS 1034 procedures were submitted. The patients were 32.1% female, mean age 63.8±10.7 years, 53.1% paroxysmal AF and 89.7% first-time AF ablation. Procedures were performed by 48 consultant operators at nine NHSE centres, with a mean of 115 procedures per centre (range 25-264). 93.7% of procedures were performed under general anaesthesia. Median skin-to-skin procedure time was 74 min (IQR 55-96 min) and fluoroscopy time 20 min (IQR 15-27 min). Electroanatomical mapping was used in 15.3%. In first-time ablation cases, acute isolation of all pulmonary veins was achieved in 99.5% of patients. Left atrial (LA) posterior wall ablation using the PFA catheter was performed in 11.0% of cases; additional LA radiofrequency ablation was performed in 0.6%. The major and minor acute procedural complication rates were, respectively, 1.3% and 3.1%, with no reports of periprocedural death or atrio-oesophageal fistula. 63.8% of patients were discharged on the day of procedure. Follow-up data were available for 870 procedures (84.1%). In the 3 months following ablation, hospitalisation for arrhythmia occurred in 3.2%, with 0.9% rehospitalised for procedural-related complications. CONCLUSION In this real-world, nationwide registry of a pentaspline PFA catheter, efficacy, safety and efficiency outcomes were comparable to those from previous PFA studies in patients with AF.
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Affiliation(s)
- Mark T Mills
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
- NHS England Cardiac Rhythm Management Device Working Group, London, UK
| | - Saket Trivedi
- NHS England Cardiac Rhythm Management Device Working Group, London, UK
| | - Matthew J Lovell
- NHS England Cardiac Rhythm Management Device Working Group, London, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Francis Murgatroyd
- NHS England Cardiac Rhythm Management Device Working Group, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Vishal Luther
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Claire Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Zeriouh
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Greg Mellor
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Mark Sopher
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Julian Boullin
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Aruna Arujuna
- Lancashire Cardiac Centre, Victoria Hospital, Blackpool Teaching Hospitals NHS Trust Foundation, Blackpool, UK
- Biomedical Engineering and Imaging Sciences Department, King’s College London, London, UK
| | - Shajil Chalil
- Lancashire Cardiac Centre, Victoria Hospital, Blackpool Teaching Hospitals NHS Trust Foundation, Blackpool, UK
| | - Scott Gall
- Lancashire Cardiac Centre, Victoria Hospital, Blackpool Teaching Hospitals NHS Trust Foundation, Blackpool, UK
| | - Zhong Chen
- Royal Brompton and Harefield Hospitals, London, UK
| | - Magdi Saba
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Una Buckley
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- St Vincent’s Private Hospital, Dublin, Ireland
| | - Riyaz Somani
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shui Hao Chin
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Jones
- Royal Brompton and Harefield Hospitals, London, UK
| | - Riyaz A Kaba
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark O'Neill
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, London, UK
| | - Derick M Todd
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
- NHS England Cardiac Rhythm Management Device Working Group, London, UK
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18
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Füting A, Neven K, Bordignon S, Reichlin T, Blaauw Y, Hansen J, Adelino R, Ouss A, Roten L, Mulder BA, Ruwald MH, Mené R, van der Voort P, Reinsch N, Kueffer T, Boveda S, Albrecht EM, Raybuck JD, Sutton B, Chun KRJ, Schmidt B. Pulsed Field Ablation as First-Line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry. Circ Arrhythm Electrophysiol 2024; 17:e013088. [PMID: 39601122 DOI: 10.1161/circep.124.013088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 10/23/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy. Examination of real-world data may shed light on clinical practices and the effectiveness of PFA with and without a prior history of AAD usage. METHODS European Real World Outcomes with Pulsed Field Ablation is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at 7 high-volume centers in Europe. This subanalysis evaluates patients with a history of class I/III AAD use versus those with no documented history of class I/III AAD use (first-line patients). Patients with incomplete AAD history, long-standing persistent AF, and those undergoing a repeat ablation procedure were excluded. Patients were treated and followed based on institutional standard of care. Any episode of atrial tachycardia or AF lasting longer than 30 s was considered an arrhythmia recurrence. RESULTS Of 1233 patients enrolled in European real world outcomes with pulsed field ablation, 1091 met the inclusion criteria (mean age, 66 years; 40% females; and persistent AF, 36%). Pulmonary vein isolation-only was used in 90% of the patients, and 10% received extra-PV ablation. Ablation as the first-line approach was chosen in 589 patients, and 502 patients had prior class I/III AAD use. In the first-line PFA group, paroxysmal AF was more frequent (68% versus 59%; P<0.001), and pulmonary vein isolation-only was more frequent (93% versus 86%; P<0.001). At 1-year follow-up, freedom from AF/atrial tachycardia recurrence was similar in the ablation-first versus the ablation after failed AAD group (78% versus 74%, respectively; P=0.076). CONCLUSION In this large real-world PFA registry, freedom from AF/atrial tachycardia recurrence after 1 year was similar in patients undergoing PFA as a first-line treatment and those with prior failed AAD therapy. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05823818.
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Affiliation(s)
- Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.)
- Department of Medicine, Witten/Herdecke University, Germany (A.F., K.N., N.R.)
| | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.)
- Department of Medicine, Witten/Herdecke University, Germany (A.F., K.N., N.R.)
| | - Stefano Bordignon
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (S. Bordignon, K.R.J.C., B. Schmidt)
| | - Tobias Reichlin
- Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (Y.B., B.A.M.)
| | - Jim Hansen
- Department of Cardiology, Arrhythmia Unit, Gentofte Hospital, Copenhagen, Denmark (J.H., M.H.R.)
| | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)
| | - Alexandre Ouss
- Department of Cardiology, Heart Center Catharina Hospital, Eindhoven, the Netherlands (A.O., P.v.d.V.)
| | - Laurent Roten
- Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (Y.B., B.A.M.)
| | - Martin H Ruwald
- Department of Cardiology, Arrhythmia Unit, Gentofte Hospital, Copenhagen, Denmark (J.H., M.H.R.)
| | - Roberto Mené
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)
| | - Pepijn van der Voort
- Department of Cardiology, Heart Center Catharina Hospital, Eindhoven, the Netherlands (A.O., P.v.d.V.)
| | - Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.)
- Department of Medicine, Witten/Herdecke University, Germany (A.F., K.N., N.R.)
| | - Thomas Kueffer
- Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)
| | | | | | - Brad Sutton
- Boston Scientific Corporation, St. Paul, MN (E.M.A., J.D.R., B. Sutton)
| | - Kyoung Ryul Julian Chun
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (S. Bordignon, K.R.J.C., B. Schmidt)
| | - Boris Schmidt
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (S. Bordignon, K.R.J.C., B. Schmidt)
- Universitätsklinikum Frankfurt, Medizinische Klinik 3: Klinik für Kardiologie, Germany (B. Schmidt)
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19
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Natale A, Mohanty S, Sanders P, Anter E, Shah A, Al Mohani G, Haissaguerre M. Catheter ablation for atrial fibrillation: indications and future perspective. Eur Heart J 2024; 45:4383-4398. [PMID: 39322413 DOI: 10.1093/eurheartj/ehae618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/12/2024] [Accepted: 08/30/2024] [Indexed: 09/27/2024] Open
Abstract
Recent advances in techniques, technologies and proven superiority over anti-arrhythmic drugs have made catheter ablation the cornerstone of management for atrial fibrillation (AF), which has shown a steady increase in prevalence in the ageing population worldwide. The aim of therapeutic interventions is to achieve stable sinus rhythm that would improve the quality of life and reduce the risk of AF-associated complications. Pulmonary veins (PVs) were first described as the source of initiation of ectopic triggers driving AF, which led to the establishment of PV isolation (PVI) as the most widely practiced procedure to treat AF. Antral PVI is still recognized as the stand-alone ablation strategy for newly diagnosed paroxysmal AF (PAF). However, in non-PAF patients, PVI seems to be inadequate and several adjunctive strategies, including ablation of left atrial posterior wall and non-PV triggers, AF mapping and ablation of rotors and drivers, ethanol infusion of vein of Marshall and renal denervation, etc. have been reported with mixed results. Recent trials have also documented the benefits of early rhythm control in preventing cardiovascular events in addition to slowing the progression of PAF to more persistent forms. Similarly, very late relapse of the arrhythmia after successful PVI has drawn attention to the critical role of non-PV triggers and highlighted their relevance as potential ablation targets during repeat procedures. Ablation technology is also under constant evolution with the introduction of non-thermal energy sources and new tools to create durable lesions. This review summarizes the indications, advancements, and future perspective of AF ablation.
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Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
- Interventional Electrophysiology, Scripps Clinic, 9898 Genesee Avenue, La Jolla, San Diego, CA 92037, USA
- Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
| | | | - Elad Anter
- Shamir Medical Center, Tel Aviv University, Israel
| | - Ashok Shah
- Haut-Lévèque Cardiology Hospital, Bordeaux, France
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Tay JCK, Tarranza JL, Chia SY, Pung XM, Loo GJM, Teo HK, Yeo C, Tan VH, Lim ETS, Chong DTT, Ho KL, Ching CK. Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond. J Cardiovasc Dev Dis 2024; 11:356. [PMID: 39590199 PMCID: PMC11595090 DOI: 10.3390/jcdd11110356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/22/2024] [Accepted: 11/04/2024] [Indexed: 11/28/2024] Open
Abstract
Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all p < 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all p > 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3-97.3] and 82.8% [95% CI, 68.1-97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications.
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Affiliation(s)
- Julian Cheong Kiat Tay
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Jannah Lee Tarranza
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Shaw Yang Chia
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Xuan Ming Pung
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Germaine Jie Min Loo
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Hooi Khee Teo
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Colin Yeo
- Department of Cardiology, Changi, General Hospital, Singapore 529889, Singapore; (C.Y.); (V.H.T.)
| | - Vern Hsen Tan
- Department of Cardiology, Changi, General Hospital, Singapore 529889, Singapore; (C.Y.); (V.H.T.)
| | - Eric Tien Siang Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Daniel Thuan Tee Chong
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Kah Leng Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore; (J.C.K.T.); (J.L.T.); (S.Y.C.); (X.M.P.); (G.J.M.L.); (H.K.T.); (E.T.S.L.); (D.T.T.C.); (K.L.H.)
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21
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Yokoyama M, Vlachos K, Ogbedeh C, Ascione C, Kowalewski C, Popa M, Monaco C, Benali K, Kneizeh K, Mené R, Arnaud M, Buliard S, Bouyer B, Tixier R, Chauvel R, Duchateau J, Pambrun T, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Anatomical Treatment Strategies for Persistent Atrial Fibrillation with Ethanol Infusion within the Vein of Marshall-Current Challenges and Future Directions. J Clin Med 2024; 13:5910. [PMID: 39407972 PMCID: PMC11477583 DOI: 10.3390/jcm13195910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/20/2024] [Accepted: 09/29/2024] [Indexed: 10/20/2024] Open
Abstract
Currently, pulmonary vein isolation (PVI) is the gold standard in catheter ablation for atrial fibrillation (AF). However, PVI alone may be insufficient in the management of persistent AF, and complementary methods are being explored. One such method takes an anatomical approach-improving both its success rate and lesion durability may lead to improved treatment outcomes. An additional approach complementary to the anatomical one is also attracting attention, one that focuses on epicardial conduction. This involves ethanol ablation of the vein of Marshall (VOM) and can be very effective in blocking epicardial conduction related to Marshall structure; it is becoming incorporated into standard treatment. However, the pitfall of this "Marshall-PLAN", a method that combines an anatomical approach with ethanol infusion within the VOM (Et-VOM), is that Et-VOM and other line creations are not always successfully completed. This has led to cases of AF and/or atrial tachycardia (AT) recurrence even after completing this lesion set. Investigating effective adjunctive methods will enable us to complete the lesion set with the aim to lower the rates of recurrence of AF and/or AT in the future.
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Affiliation(s)
- Masaaki Yokoyama
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Chizute Ogbedeh
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | - Ciro Ascione
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Christopher Kowalewski
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Miruna Popa
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Cinzia Monaco
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Karim Benali
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
- Saint-Etienne University Hospital Center, Saint-Etienne University, 42100 Saint-Étienne, France
| | - Kinan Kneizeh
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Roberto Mené
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Marine Arnaud
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Samuel Buliard
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Benjamin Bouyer
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Bordeaux-Pessac, France
- IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, 33604 Bordeaux-Pessac, France
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22
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Pranata R, Kamarullah W, Karwiky G, Achmad C, Iqbal M. Left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation for atrial fibrillation: A systematic review and meta-analysis. Heart Rhythm O2 2024; 5:720-727. [PMID: 39524056 PMCID: PMC11549642 DOI: 10.1016/j.hroo.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Persistent atrial fibrillation (AF) may require extensive ablation strategies. Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsed-field ablation (PFA). OBJECTIVE This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF. METHODS Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAPWI+PVI using a pentaspline catheter in PFA ablation for AF. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period. RESULTS There were 882 patients from 7 studies. The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications. In mean follow-up of 240 ± 91 days, ATa recurrence was 21% (95% CI 13%-29%; I2 = 84.8%) in the LAPWI+PVI group. Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence (P > .05). Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R2 = 100%, P < .001, I2 = 0%). Meta-analysis showed no difference in terms of ATa recurrence among LAPWI+PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50-1.21, P = .27; I2 = 0%, P = .86). Procedure time and fluoroscopy time did not significantly differ (P > .05). CONCLUSION LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence. LAPWI may be considered during PFA, although the benefit is uncertain.
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Affiliation(s)
- Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Kota Bandung, Jawa Barat, Indonesia
| | - William Kamarullah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Kota Bandung, Jawa Barat, Indonesia
| | - Giky Karwiky
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Kota Bandung, Jawa Barat, Indonesia
| | - Chaerul Achmad
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Kota Bandung, Jawa Barat, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Kota Bandung, Jawa Barat, Indonesia
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23
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Mannakkara NN, Khan I, Ghazanfar A, Wijesuriya N, Mehta VS, De Vere F, Howell S, Adhya S, Porter B, Child N, Razavi R, Rinaldi CA, Bosco P, Blauth C, Gill JS. Convergent ablation for persistent atrial fibrillation: A UK multicentre perspective. J Cardiovasc Electrophysiol 2024; 35:2039-2052. [PMID: 39136365 DOI: 10.1111/jce.16399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/23/2024] [Accepted: 07/30/2024] [Indexed: 10/11/2024]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and remains a major cause of morbidity and mortality. Unfortunately, a significant proportion of patients have persistent AF, for which conventional catheter ablation is less effective. However, convergent ablation has emerged in recent years as a hybrid treatment targeting both the epicardium and endocardium in a multidisciplinary joint cardiothoracic and electrophysiology procedure, with promising efficacy outcomes in recent studies. This treatment is increasingly being performed in the United Kingdom. This review article discusses the rationale and evidence behind convergent ablation, along with factors that need to be considered when setting up a successful ablation service.
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Affiliation(s)
- Nilanka N Mannakkara
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ibrar Khan
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
| | - Auns Ghazanfar
- Department of Cardiology, St. Richard's Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Nadeev Wijesuriya
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Vishal S Mehta
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Felicity De Vere
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sandra Howell
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shaumik Adhya
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- Department of Cardiology, Medway Maritime Hospital, Gillingham, UK
| | - Bradley Porter
- South West Cardiothoracic Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Nicholas Child
- Department of Cardiology, St. Richard's Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christopher A Rinaldi
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Paolo Bosco
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
| | - Christopher Blauth
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
| | - Jaswinder S Gill
- Department of Cardiovascular Services, Guy's and St. Thomas' Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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24
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Conti S, Sabatino F, Randazzo G, Ferrara G, Cascino A, Sgarito G. High-Power Short-Duration Posterior Wall Isolation in Addition to Pulmonary Vein Isolation in Persistent Atrial Fibrillation Ablation Using the New TactiFlex™ Ablation Catheter. J Cardiovasc Dev Dis 2024; 11:294. [PMID: 39330352 PMCID: PMC11432285 DOI: 10.3390/jcdd11090294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND The TactiFlex™ ablation catheter, Sensor Enabled™ (Abbott, Minneapolis, MN, USA), is an open-irrigation radiofrequency (RF) ablation catheter with flexible tip technology. This catheter delivers high-power short-duration (HPSD) RF ablations and has been adopted for atrial fibrillation (AF) ablation. HPSD is well-established not only in pulmonary vein isolation (PVI) but also when targeting extra-pulmonary vein (PV) targets. This study aims to determine the safety, effectiveness, and acute outcomes of PVI plus posterior wall isolation (PWI) in patients with persistent atrial fibrillation (Pe-AF) using HPSD and the TactiFlex™ ablation catheter. METHODS Consecutive patients who underwent the ablation of Pe-AF in our centre between February 2023 and February 2024 were prospectively enrolled in the study. All patients underwent PVI plus PWI using TactiFlex™ and the HPSD strategy. The RF parameters were 50 W on all the PV segments and the roof, and within the posterior wall (PW). Left atrial mapping was performed with the EnSite X mapping system and the high-density multipolar Advisor HD Grid, Sensor Enabled™ mapping catheter. We compared the procedural data using HPSD with TactiFlex™ (n = 52) vs. a historical cohort of patients who underwent PVI plus PWI using HPSD settings and the TactiCath ablation catheter (n = 84). RESULTS Fifty-two consecutive patients were included in the study. PVI and PWI were achieved in all patients in the TactiFlex™ group. First-pass PVI was achieved in 97.9% of PVs (n = 195/199). PWI was obtained in all cases by delivering extensive RF lesions within the PW. There were no significant differences compared to the TactiCath group: first-pass PVI was achieved in 96.3% of PVs (n = 319/331). Adenosine administration revealed PV reconnection in 5.7% of patients, and two reconnections of the PW were documented. Procedure and RF time were significantly shorter in the TactiFlex™ group compared to the TactiCath group, 73.1 ± 12.6 vs. 98.5 ± 16.3 min, and 11.3 ± 1.5 vs. 23.5 ± 3.6 min, respectively, p < 0.001. The fluoroscopy time was comparable between both groups. No intraprocedural and periprocedural complications related to the ablation catheter were observed. Patients had an implantable loop recorder before discharge. At the 6-month follow-up, 76.8% of patients remained free from atrial arrhythmia, with no significant differences between groups. CONCLUSIONS HPSD PVI plus PWI using the TactiFlex™ ablation catheter is effective and safe. Compared to a control group, the use of TactiFlex™ to perform HPSD PVI plus PWI is associated with a similar effectiveness but with a significantly shorter procedural and RF time.
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Affiliation(s)
- Sergio Conti
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Francesco Sabatino
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Giulia Randazzo
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Giuliano Ferrara
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Antonio Cascino
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Giuseppe Sgarito
- Department of Electrophysiology, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
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Gupta A, Sundhu M, Reddy M, Sheldon SH, Noheria A. Sequential Isolation of Persistent Left Superior Vena Cava and Right Superior Vena Cava Using Pulsed-field Ablation with a Pentaspline Catheter for Recurrent Persistent Atrial Fibrillation. J Innov Card Rhythm Manag 2024; 15:6004-6010. [PMID: 39371449 PMCID: PMC11448739 DOI: 10.19102/icrm.2024.15092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/21/2024] [Indexed: 10/08/2024] Open
Abstract
Pulsed-field ablation (PFA) is a novel technology for atrial fibrillation (AF) ablation that can deliver energy precisely with a lower risk of damage to the surrounding organs. Persistent left superior vena cava (PLSVC) is a congenital variant that can act as a driver of AF, and its isolation may be required in recurrent persistent AF. We describe a case where PFA was used for isolation of the right superior vena cava, PLSVC, and posterior wall of the left atrium.
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Affiliation(s)
- Amulya Gupta
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Murtaza Sundhu
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Seth H. Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
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26
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Kordić LL, Jurišić Z, Brešković T, Sikirić I, Katić J, Dagelic M, Anić A. Safety and effectiveness of additional left atrial posterior wall ablation using pulsed field ablation for persistent and long-standing persistent atrial fibrillation patients. J Cardiovasc Electrophysiol 2024; 35:1525-1535. [PMID: 38803029 DOI: 10.1111/jce.16326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The unique safety profile of pulsed field ablation (PFA) has made pulmonary vein isolation (PVI) + left atrial posterior wall (LAPW) ablation promising for treating persistent atrial fibrillation (PerAF). The goal of this study was to assess long-term freedom from atrial fibrillation, atrial flutter, and atrial tachycardia (AF/AFL/AT), as well as the safety and feasibility of LAPW PFA using multipolar, pentaspline Farawave catheter. METHODS Retrospective observational study at a single institution. Data for 94 patients were collected from a prespecified intraprocedural registry. The long-term AF/AFL/AT recurrence assessment was based on an analysis of medical history; 24-h Holter ECGs at 3, 6, and 12 months postablation; and 12-lead ECGs recorded during symptomatic episodes or visits. RESULTS Half of the patients had ls-PerAF, and half had a history of catheter ablation-mostly RF PVI. The acute ablation success rate was 100%, and the primary safety outcome was observed in 2 patients. Fifty patients experienced AF/AFL/AT recurrence (54.3%). An increase in LAPW low-voltage areas and AF classification were associated with arrhythmia recurrence. After a median follow-up of 13 months, the Kaplan‒Meier estimated median time free of AF/AFL/AT after a single procedure was 14.7 months. CONCLUSION PFA PVI + PWA had the best outcome in perAF patients without extensive LA fibrosis. AF recurrence was paroxysmal in significant part of the cohort. The addition of PWA to PVI using multipolar PFA was safe and did not significantly influence the transpired ablation time.
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Affiliation(s)
| | | | | | | | - Josip Katić
- Split Clinical Hospital Centre, Split, Croatia
| | | | - Ante Anić
- Split Clinical Hospital Centre, Split, Croatia
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Kueffer T, Stettler R, Maurhofer J, Madaffari A, Stefanova A, Iqbal SUR, Thalmann G, Kozhuharov NA, Galuszka O, Servatius H, Haeberlin A, Noti F, Tanner H, Roten L, Reichlin T. Pulsed-field vs cryoballoon vs radiofrequency ablation: Outcomes after pulmonary vein isolation in patients with persistent atrial fibrillation. Heart Rhythm 2024; 21:1227-1235. [PMID: 38614191 DOI: 10.1016/j.hrthm.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Pulsed-field ablation (PFA) has shown promising data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI), with similar long-term outcomes compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF). OBJECTIVE The purpose of this study was to compare the procedural and long-term outcomes in patients with persistent AF undergoing PVI using PFA, CBA, or RFA. METHODS Consecutive patients with persistent AF undergoing first PVI with PFA, CBA, or RFA were included. Patients underwent 7-day Holter electrocardiography at 3, 6, and 12 months postablation. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period. Safety outcomes included the composite of in-hospital major adverse events. RESULTS A total of 533 patients with persistent AF underwent PVI using PFA (n = 214, 39%), CBA (n = 190, 36%), or RFA (n = 129, 24%). Procedures with PFA guided by fluoroscopy were shorter than those with CBA (median 60 minutes; interquartile range [IQR] 53-80 minutes vs 84 minutes; IQR 68-101 minutes; P ≤ .001), and procedures with PFA in combination with 3-dimensional electroanatomic mapping were shorter than those with RFA (median 101 minutes; IQR 85-126 minutes vs 171 minutes; IQR 141-204 minutes; P < .001). Acute safety events occurred in 2.3%, 2.6%, and 0.8% in the PFA, CBA, and RFA groups, respectively (P = .545). The 1-year confounder-adjusted estimate for freedom from atrial arrhythmias was 62.1% for CBA, 55.3% for PFA, and 48.3% for RFA (CBA vs PFA: P = .79; CBA vs RFA: P = .009; PFA vs RFA: P = .010). CONCLUSION In patients with persistent AF undergoing first PVI, 1-year confounder-adjusted outcomes are better with PFA and CBA than with RFA.
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Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; SITEM Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Robin Stettler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita Stefanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salik Ur Rehman Iqbal
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola A Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; SITEM Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Ollitrault P, Chaumont C, Font J, Manninger M, Conti S, Matusik PT, Mulder BA, Ferchaud V, Pellissier A, Al Khoury M, Milliez P, Champ-Rigot L, Anselme F. Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation. Europace 2024; 26:euae160. [PMID: 38875490 PMCID: PMC11252500 DOI: 10.1093/europace/euae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/14/2024] [Indexed: 06/16/2024] Open
Abstract
AIMS Superior vena cava (SVC) isolation during atrial fibrillation catheter ablation is limited by the risk of collateral damage to the sinus node and/or the phrenic nerve. Due to its tissue-specificity, we hypothesized the feasibility and safety of pulsed-field ablation (PFA)-based SVC isolation. METHODS AND RESULTS One hundred and five consecutive patients undergoing PFA-based AF catheter ablation were prospectively included. After pulmonary vein isolation (±posterior wall isolation and electrical cardioversion), SVC isolation was performed using a standardized workflow. Acute SVC isolation was achieved in 105/105 (100%) patients after 6 ± 1 applications. Transient phrenic nerve stunning occurred in 67/105 (64%) patients but without phrenic nerve palsy at the end of the procedure and at hospital discharge. Transient high-degree sinus node dysfunction occurred in 5/105 (4.7%) patients, with no recurrence at the end of the procedure and until discharge. At the 3-month follow-up visit, no complication occurred. CONCLUSION SVC isolation using a pentaspline PFA catheter is feasible and safe.
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Affiliation(s)
- Pierre Ollitrault
- Electrophysiology Unit, Department of Cardiology, Regional University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Corentin Chaumont
- Department of Cardiology, Rouen University Medical Center, Rue de Germont, 76031 Rouen, France
| | - Jonaz Font
- Electrophysiology Unit, Department of Cardiology, Regional University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
- Department of Cardiology, Pôle de Formation et de Recherche en Santé, Rue des Rochambelles, 14000 Caen, France
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medical, Graz University Medical Center, Graz, Austria
| | - Sergio Conti
- Department of Cardiology, ARNAS Civico Hospital, Palermo, Italy
| | - Paweł T Matusik
- Department of Cardiology, St. John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Prądnicka 80, 31-202 Kraków, Poland
| | - Bart A Mulder
- Department of Cardiology, Groningen University Medical Center, Groningen, The Netherlands
| | - Virginie Ferchaud
- Electrophysiology Unit, Department of Cardiology, Regional University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Arnaud Pellissier
- Electrophysiology Unit, Department of Cardiology, Regional University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Mayane Al Khoury
- Electrophysiology Unit, Department of Cardiology, Regional University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Paul Milliez
- Electrophysiology Unit, Department of Cardiology, Regional University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
- Department of Cardiology, Pôle de Formation et de Recherche en Santé, Rue des Rochambelles, 14000 Caen, France
| | - Laure Champ-Rigot
- Electrophysiology Unit, Department of Cardiology, Regional University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Frédéric Anselme
- Department of Cardiology, Rouen University Medical Center, Rue de Germont, 76031 Rouen, France
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Beney J, Galea R, Siontis G, Gräni C, Kueffer T, Brugger N, Reichlin T, Räber L, Roten L. Feasibility study on atrial fibrillation ablation with pulsed field ablation and concomitant occlusion of the left atrial appendage. Europace 2024; 26:euae176. [PMID: 38917059 PMCID: PMC11242437 DOI: 10.1093/europace/euae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
AIMS Atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) are increasingly performed as individual procedures. Pulsed field ablation (PFA) has significantly reduced procedure duration and may be advantageous for the combined approach. METHODS AND RESULTS We have launched a programme for simultaneous AF ablation using PFA and LAAO for patients qualifying for both treatments and excluding those with a complex anatomy. We compare procedure duration and fluoroscopy time against individual procedures (either AF ablation or LAAO alone), all performed by the same operators and using consistent technologies. We performed the combined procedure in 10 patients (50% males; median age 70 years) and excluded 2 patients (17%) because of a complex left atrial appendage anatomy. No death, stroke, or major bleeding events, including pericardial effusion, occurred. For single-procedure comparison, 207 AF ablation procedures and 61 LAAO procedures were available. The total median procedure duration was 79 min (range 60-125) for the combined procedure, 71 min (25-241) for individual AF ablation (51 min without and 78 min with 3-dimensional electroanatomic mapping), and 47 min (15-162) for individual LAAO. The respective fluoroscopy times were 21 (15-26), 15 (5-44), and 10 (3-50) min. For the combined procedure, femoral vein access to last PFA application lasted 49 min (34-93) and LAAO added 20 min (15-37). CONCLUSION Simultaneous PFA-based AF ablation and LAAO in carefully selected patients is feasible and safe and can be executed within a short overall procedure duration.
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Affiliation(s)
- Jennifer Beney
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Georgios Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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30
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Bianchini L, Schiavone M, Vettor G, Gasperetti A, Penza E, Ballotta A, Pirola S, Brambillasca C, Zito E, De Lio F, Ventrella N, Tundo F, Moltrasio M, Fassini G, Polvani G, Tondo C. Hybrid-Convergent Procedure or Pulsed Field Ablation in Long-Standing Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2024; 10:1700-1710. [PMID: 39084744 DOI: 10.1016/j.jacep.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/14/2024] [Accepted: 05/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Hybrid-convergent radiofrequency (RF) ablation targeting pulmonary veins (PVs) and left atrial posterior wall (LAPW) has shown better arrhythmic outcomes than an endocardial-only RF strategy, despite higher rates of complications. Comparisons with extensive pulsed field ablation (PFA) are currently lacking. OBJECTIVES This study aimed to compare the efficacy and safety of the hybrid-convergent RF vs PFA of PVs and LAPW in long-standing persistent atrial fibrillation (LSPAF). METHODS Ninety-three consecutive LSPAF patients, treated with 2-step hybrid-convergent RF ablation (hybrid group, n = 49) or with PFA of PVs and LAPW (PFA group, n = 44) were enrolled. Primary efficacy endpoint was defined as any atrial tachyarrhythmias (ATA) recurrence after the 3-month blanking period, over a follow-up time of 12 months. Periprocedural adverse events and late complications during follow-up were deemed primary safety outcomes. RESULTS The hybrid and PFA groups had similar baseline characteristics; mean age was hybrid 63.8 ± 10.6 years vs PFA 66.0 ± 7.4 years; P = 0.105. PV and LAPW ablation were acutely successful in all patients. Step 1 hybrid-epicardial procedures were longer than PFA (166 [Q1-Q3: 140-205] minutes vs 107.5 [Q1-Q3: 82.5-12] minutes; P < 0.01). At 12-month follow-up, there was no difference in ATA recurrences between groups (hybrid 36.7% vs PFA 40.9%; P = 0.680; log-rank at survival analysis P = 0.539). After adjusting for confounders, a larger left atrial volume and recurrences during the blanking-period were predictors of ATA recurrences after ablation, regardless of procedural technique employed. PFA showed a better safety profile with a lower rate of major periprocedural complications compared with hybrid ablation (12% vs 0%; P = 0.028). CONCLUSIONS Hybrid-convergent and PFA share comparable arrhythmic outcomes in LSPAF, but hybrid-convergent ablation carries higher periprocedural risks.
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Affiliation(s)
- Lorenzo Bianchini
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Marco Schiavone
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Giulia Vettor
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eleonora Penza
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Andrea Ballotta
- Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Anaesthesia and Intensive Care Unit, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Sergio Pirola
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Claudio Brambillasca
- Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Anaesthesia and Intensive Care Unit, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | | | - Francesca De Lio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | | | - Fabrizio Tundo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Gaetano Fassini
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCSS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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31
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Lim MW, Morton M, Fernando R, Elbracht-Leong S, Better N, Segan L, William J, Crowley R, Morton JB, Sparks PB, Lee G, McLellan AJ, Ling LH, Sugumar H, Prabhu S, Voskoboinik A, Kalman JM, Kistler PM. Impact of Posterior Wall Isolation During AF Ablation on the Incidence of Left Atrial Flutter. JACC Clin Electrophysiol 2024; 10:1620-1630. [PMID: 38752960 DOI: 10.1016/j.jacep.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Linear and complex electrogram ablation (LCEA) beyond pulmonary vein isolation (PVI) is associated with an increase in left atrial macro-re-entrant tachycardias (LAMTs). Posterior wall isolation (PWI) is increasingly performed to improve AF ablation outcomes. However, the impact of PWI on the incidence of LAMT is unknown. OBJECTIVES The purpose of this study was to establish the incidence of LAMT following PVI alone vs PVI + PWI vs PVI + PWI + LCEA. METHODS Consecutive patients undergoing catheter ablation for AF or LAMT post-AF ablation between 2008 and 2022 from 4 electrophysiology centers were reviewed with a minimum follow-up of 12 months. RESULTS In total, 5,619 (4,419 index, 1,100 redo) AF ablation procedures were performed in 4,783 patients (mean age 60.9 ± 10.6 years, 70.7% men). Over a mean follow-up of 6.4 ± 3.8 years, 246 procedures for LAMT were performed in 214 patients at a mean of 2.6 ± 0.6 years post-AF ablation. Perimitral (52.8% of patients), roof-dependent (27.1%), PV gap-related (17.3%), and anterior circuits (8.9%) were most common, with 16.4% demonstrating multiple circuits. The incidence of LAMT was significantly higher following PVI + PWI (6.2%) vs PVI alone (3.0%; P < 0.0001) and following PVI + PWI + LCEA vs PVI + PWI (12.5%; P = 0.019). Conduction gaps in previous ablation lines were responsible for LAMT in 28.4% post-PVI alone, 35.3% post-PVI + PWI (P = 0.386), and 81.8% post-PVI + PWI + LCEA (P < 0.005). CONCLUSIONS The incidence of LAMT following PVI + PWI is higher than with PVI alone but significantly lower than with more extensive atrial substrate modification. Given a low frequency of LAMT following PWI, empiric mitral isthmus ablation is not justified and may be proarrhythmic.
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Affiliation(s)
- Michael W Lim
- The Alfred Hospital, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | | | | | | | - Nathan Better
- The Royal Melbourne Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Louise Segan
- The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Jeremy William
- The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Rose Crowley
- The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Joseph B Morton
- The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia
| | - Paul B Sparks
- The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia
| | - Geoffrey Lee
- The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Alex J McLellan
- The Royal Melbourne Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; St Vincent's Health, Melbourne, Victoria, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia
| | - Hariharan Sugumar
- The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; Monash University, Melbourne, Australia; St Vincent's Health, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Aleksandr Voskoboinik
- The Alfred Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Western Health, Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- The Royal Melbourne Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Peter M Kistler
- The Alfred Hospital, Melbourne, Australia; Melbourne Private Hospital, Melbourne, Australia; Cabrini Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Monash University, Melbourne, Australia.
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Feld GK, Hsu JC. Atypical Left Atrial Flutter After Posterior Wall and Pulmonary Vein Isolation Atrial Fibrillation. JACC Clin Electrophysiol 2024; 10:1631-1633. [PMID: 38852102 DOI: 10.1016/j.jacep.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Gregory K Feld
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Section, University of California-San Diego Health System, La Jolla, California, USA.
| | - Jonathan C Hsu
- Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Section, University of California-San Diego Health System, La Jolla, California, USA
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Chun KRJ, Miklavčič D, Vlachos K, Bordignon S, Scherr D, Jais P, Schmidt B. State-of-the-art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective. Europace 2024; 26:euae134. [PMID: 38848447 PMCID: PMC11160504 DOI: 10.1093/europace/euae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Pulsed field ablation (PFA) is an innovative approach in the field of cardiac electrophysiology aimed at treating cardiac arrhythmias. Unlike traditional catheter ablation energies, which use radiofrequency or cryothermal energy to create lesions in the heart, PFA utilizes pulsed electric fields to induce irreversible electroporation, leading to targeted tissue destruction. This state-of-the-art review summarizes biophysical principles and clinical applications of PFA, highlighting its potential advantages over conventional ablation methods. Clinical data of contemporary PFA devices are discussed, which combine predictable procedural outcomes and a reduced risk of thermal collateral damage. Overall, these technological developments have propelled the rapid evolution of contemporary PFA catheters, with future advancements potentially impacting patient care.
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Affiliation(s)
- Kyoung-Ryul Julian Chun
- CCB Frankfurt, Med. Klinik III, Markuskrankenhaus, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
- Klinik für Rhythmologie, UKSH, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, Laboratory of Biocybernetics, University of Ljubljana, Trzaska cesta 25, SI-1000 Ljubljana, Slovenia
| | - Konstantinos Vlachos
- Site Hôpital Xavier Arnozan, Bordeaux University Hospital, University of Bordeaux, Avenue du Haut-Lévêque, –Pessac, France
| | - Stefano Bordignon
- CCB Frankfurt, Med. Klinik III, Markuskrankenhaus, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
| | - Daniel Scherr
- Klinische Abteilung für Kardiologie, Medizinische Universität Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Pierre Jais
- Site Hôpital Xavier Arnozan, Bordeaux University Hospital, University of Bordeaux, Avenue du Haut-Lévêque, –Pessac, France
| | - Boris Schmidt
- CCB Frankfurt, Med. Klinik III, Markuskrankenhaus, Wilhelm-Epstein Str. 4, 60431 Frankfurt, Germany
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Canpolat U. The Yin and Yang of the persistent atrial fibrillation catheter ablation: Posterior wall isolation and novel pulsed field ablation technology. J Cardiovasc Electrophysiol 2024; 35:1112-1114. [PMID: 38571279 DOI: 10.1111/jce.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Ugur Canpolat
- Department of Cardiology, Arrhythmia, and Electrophysiology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Maurhofer J, Tanner H, Kueffer T, Madaffari A, Thalmann G, Kozhuharov N, Galuszka O, Servatius H, Haeberlin A, Noti F, Roten L, Reichlin T. Pulsed-field ablation for repeat procedures after failed prior thermal ablation for atrial fibrillation. Heart Rhythm O2 2024; 5:257-265. [PMID: 38840763 PMCID: PMC11148502 DOI: 10.1016/j.hroo.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Pulsed-field ablation (PFA) is a novel nonthermal ablation technology. Its potential value for repeat procedures after unsuccessful thermal ablation for atrial fibrillation has not been assessed. Objective The purpose of this study was to summarize our initial experience with patients undergoing repeat procedures using PFA. Methods Consecutive patients with arrhythmia recurrences after a prior thermal ablation undergoing a repeat procedure using a multipolar PFA catheter from May 2021 and December 2022 were included. After 3-dimensional electroanatomic mapping, reconnected pulmonary veins (PVs) were reisolated and veins with only ostial isolation wither ablated to widen antral PV isolation. Posterior wall ablation was performed if all PVs were durably isolated or in case of low-voltage areas on the posterior wall at the discretion of the operator. Patients underwent follow-up with 7-day Holter electrocardiography after 3, 6, and 12 months. Results A total of 186 patients undergoing a repeat procedure using PFA were included. The median number of previous ablations was 1 (range 1-6). The prior ablation modality was radiofrequency in 129 patients (69.4%), cryoballoon in 51 (27.4%), and epicardial ablation in 6 (3.2%). At the beginning of the procedure, 258 of 744 PVs (35%) showed reconnections. Additional antral ablations were applied in 236 of 486 still isolated veins (49%). Posterior wall ablation was added in 125 patients (67%). Major complications occurred in 1 patient (transient ischemic attack 0.5%). Freedom from arrhythmia recurrence in Kaplan-Meier-analysis was 78% after 6 months and 54% after 12 months. Conclusion PFA is a versatile and safe option for repeat procedures after failed prior thermal ablation.
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Affiliation(s)
- Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Farnir F, Chaldoupi SM, Farnir F, Schotten U, Vernooy K, Luermans J, Linz D. Focal point-by-point biphasic monopolar pulsed field ablation for posterior wall isolation. Europace 2024; 26:euae077. [PMID: 38517287 PMCID: PMC11017520 DOI: 10.1093/europace/euae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Florent Farnir
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Frédéric Farnir
- Department of Biostatistics and Bioinformatics, FARAH, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Ulrich Schotten
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Gunawardene MA, Harloff T, Jularic M, Dickow J, Wahedi R, Anwar O, Wohlmuth P, Gessler N, Hartmann J, Willems S. Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping. Europace 2024; 26:euae072. [PMID: 38513110 PMCID: PMC11034699 DOI: 10.1093/europace/euae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT. METHODS AND RESULTS Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P < 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11-7.65), P = 0.0473]. CONCLUSION Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.
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Affiliation(s)
- Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Tim Harloff
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Jannis Dickow
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Peter Wohlmuth
- Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
- Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
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