AB-452675-1 ELECTROPHYSIOLOGICAL FINDINGS DURING REDO PROCEDURES AFTER PULSED FIELD ABLATION USING A PENTASPLINE CATHETER TO TREAT ATRIAL FIBRILLATION IN ROUTINE CLINICAL PRACTIC

Abstract

Data from clinical trials of pulsed field ablation (PFA) to treat atrial fibrillation (AF) indicate highly-efficient workflow, an excellent safety profile, good clinical outcomes with few AF recurrences. Also strikingly, protocol-directed invasive remapping procedures revealed a high degree of durability of the pulmonary vein isolation (PVI) lesion sets. While quite favorable, PVI durability in carefully-monitored protocols may not translate to day-to-day clinical practice. Assessing durability with routine invasive remapping is not possible in routine clinical practice, but the “electrical status” of the PVs during clinical redo procedures provides compelling insights into the technical efficacy of the index procedure. To evaluate the electrophysiologic findings during redo procedures in AF patients initially treated with PFA. This single-center study included all redo ablations after an index PFA using the pentaspline catheter (Farapulse; BSC Inc.); patients in clinical trials were excluded. During the redo case, all PVs and any other lesions we assessed. Redo ablation was performed using either RF or PF energy, per operator preference. Between April 2021 (time of PFA approval) and Nov 2022, 863 consecutive AF ablations were performed using the pentaspline PFA catheter in our center. Clinically-indicated redo procedures were performed in 28 (3.2%) patients: mean age 66 yrs, 17M/11W, BMI 29, LA size 46 mm, PAF/PerAF 17/11. Mapping revealed reconductions (gaps) in 33 of 110 (30%) PVs (gaps seen in 18 pts). The distribution of the reconnections was slightly higher in the right PVs: RSPV 9, RIPV 11, LSPV 7, LIPV 6, LCPV 2. For other lesions placed during the index procedure, reconduction was observed in: 3 of 6 (50%) pts with mitral lines, 1 of 6 (17%) pts with posterior box, and 2 of 2 (100%) pts with left atrial appendage isolation. In 2 pts with initially paroxysmal AF and durable PVI, peri-mitral flutter was the clinical tachycardia, in 1 patient the symptomatic tachycardia was typical AVNRT. Only a minimal number (3,2%) of 863 patients (outside of those enrolled in clinical trials) after PF ablation of atrial fibrillation using Farapulse system underwent reablation for recurrent atrial tachyarrhythmia in our center. Even after PF ablation, gaps in the pulmonary veins remain the most common finding – 30% of treated veins were not permanently isolated.