PE-452787-3 INITIAL EXPERIENCE OF PULSED FIELD ABLATION OF ATRIAL FIBRILLATION AND ATRIAL TACHYCARDIA IN ADULT PATIENTS WITH CONGENITAL HEART DISEASE

Abstract

Prevalence of atrial tachycardias (AT) and atrial fibrillation (AF) is increasing in adult patients with congenital heart disease (CHD) significantly contributing to morbidity. Catheter ablation of AT and AF in the adult CHD population is challenging and recurrence is significant. Pulsed field ablation (PFA) is a new, non-thermal energy source for catheter ablation of AF. Due to its inherent properties of creating effective ablation lesions without permanent affection of non-myocardial tissue, it is attractive for the use in the adult CHD population. To date, its use in the adult CHD population has not been reported. This study describes initial experience of PFA of AT and AF in adult CHD patients. Prospective enrollment of adult CHD patients with a history of recurrent AT/AF, who had prior radiofrequency (RFA)/cryoenergy (Cryo) ablation of AT/AF. A high-density map using a 3D mapping system (EnSite™ Precision; Abbott) in conjunction with a high-density catheter (Advisor™ HD Grid; Abbott) was performed prior and after PFA. PFA was performed using the FARAWAVE™ ablation catheter (Boston Scientific) and applying repeated 2 kV pulses (2.5 s each) to the respective substrate. Procedural success was defined as complete substrate ablation (residual atrial electrograms < 0.05 mV on voltage map). Four adult CHD patients with recurrent AT/AF despite repeated previous RFA/cryoablation were enrolled. 2/4 had interrupted inferior V. cava and a transhepatic access was used to get access to the left atrium. PFA of all pulmonary vein ostia and the left atrial posterior wall was performed in 3 subjects. Additional PFA of a septal low voltage area was achieved in one of these patients. In the fourth patient with Ebstein’s anomaly, PFA of the cavotricuspid isthmus (CTI) and of a conduction gap within the crista terminalis was performed. Complete procedural success was achieved in all patients. Transient, fully reversible spasm of the right coronary artery without ECG changes occurred after PFA within the CTI. No recurrence of AT/AF was observed during follow-up of 5 months. Herein, we report for the first time the use of PFA in adult CHD patients with recurrent AT/AF. PFA turned out to be effective and generally safe. When using it in proximity to the coronary arteries, one must be aware of reversible coronary artery spasm. PFA might be a valuable tool to improve mid- and long-term outcome of AT/AF ablation in the adult CHD population.