One year of atrial fibrillation ablation using pulsed-field pentaspline catheter - learning curves based on a single centre experience

Abstract

Abstract Introduction Pulsed-field ablation (PFA) represents a novel nonthermal strategy for ablation of atrial fibrillation (AF). As the technology has recently emerged in routine clinical praxis, only limited data on learning curves exist so far. Hereby, we present data from our centre regarding learning curves after the first year of using PFA. Methods The ablation procedure was performed under deep sedation or general anaesthesia in patients with paroxysmal or persistent AF. No 3D mapping system was used, procedures were guided by fluoroscopy and intracardiac echocardiography. For ablation itself, a pantaspline over-the-wire catheter with a steerable sheath was used. The following parameters were analysed over the course of time: procedure time, left atrial (LA) catheter dwelling time, total fluoroscopy time, and complications. Patients who received pulmonary vein isolation (PVI) alone and those with another additive set of lesions (PVI+) were analysed separately. Procedural parameters of the first and the last 20 patients of each group were compared for statistical significance. Results A total number of consecutive 159 patients (mean age 63.20 ± 10.51 years, 69.40 % males) were included in the analysis (PVI N = 73 (45.91 %), PVI+ N = 83 (54.09 %)). Procedures were performed by 3 certified electrophysiology specialists usually in random teams of 2 operators. The mean procedure time was 62.59 ± 23.09 min (PVI 59.64 ± 27.27; PVI+ 65.09 ± 18.64 min, P = 0.15). Over time, there was a non-significant decrease in PVI group (60.30 ± 17.44 vs. 52.75 ± 16.33 min, P = 0.16), but no difference in PVI+ cohort (67.85 ± 13.31 vs. 67.65 ± 28.88 min, P = 0.97). The mean LA catheter dwelling time was 39.84 ± 13.52 min (PVI 35.04 ± 10.20 min; PVI+ 44.33 ± 14.72 min, P <0.001). Non-significant shortening of the LA dwelling time was observed in PVI patients (36.56 ± 8.0 vs. 33.37 ± 9.58 min, P = 0.29). In contrast, the LA dwelling time in the PVI+ group became non-significantly longer (42.93 ± 10.62 vs. 48.56 ± 22.28 min, P = 0.39). The mean fluoroscopy time was 9.28 ± 3.66 min (PVI 8.65 ± 3.04; PVI+ 9.80 ± 4.05 min, P = 0.043). Importantly, fluoroscopy time decreased significantly in both groups over time (PVI: 10.63 ± 3.51 vs. 6.95 ± 2.45 min, P <0.001; PVI+: 12.82 ± 4.99 vs. 9.13 ± 4.16 min, P = 0.017). Regarding complications, we observed one pulmonary oedema requiring orotracheal intubation and mechanical ventilation in the early period. Other complications were related to the femoral puncture site. Conclusion Over the course of time with the new PFA technology, we observed a significant decrease in total fluoroscopy time. However, the change in total procedure and LA dwelling time did not reach statistical significance.