First real-world experience with pulmonary vein isolation using pulsed field ablation for paroxysmal atrial fibrillation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation for AF using thermal energy can cause collateral damage. Pulsed field ablation (PFA) is a novel nonthermal energy source. Only a few small clinical studies have been published. Objective We report on the first “real-world” experience with PVI using PFA for paroxysmal AF. Methods Pre and post ablation, phrenic nerve function was assessed. A high-density LA bipolar voltage map was created. All PVs were individually isolated using a steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation. Results In 30 patients (63 years; 47% male), uncomplicated PFA was performed, with all PVs isolated. Procedure time was 116 min. PFA catheter LA dwell time was 29 min. Fluoroscopy time was 26 min. (All values are median). In 1 patient with roof dependent flutter, a roof line was intentionally created. In 2 patients, unintentional bidirectional mitral isthmus block was created. There was no phrenic nerve or esophageal damage. In 1 patient, pericardial drainage after cardiac tamponade was performed. In-hospital stay, and 30-day follow-up were uneventful. After 90 days, 97% of patients were in sinus rhythm. Conclusion PVI using PFA for paroxysmal AF in a “real-world” setting is safe and feasible. Procedure and ablation times are short. Atrial ablation lines can easily be created. Unintentional ablation of atrial tissue can occur, accurate catheter alignment to the PV ostium and PV axis should be ensured. Figure: Postero-anterior view of a LA bipolar voltage 3D map. Left panel: pre ablation. Magenta areas in the PVs are conducting (>0,5 mV). Right panel: post ablation. Non-magenta (<0,5 mV) and red (<0,1 mV) areas in the PVs are ablated and electrically silent.