Posterior wall ablation by pulsed-field ablation : procedural safety, efficacy, and findings on redo procedures
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology..
AIMS: The left atrial posterior wall is a potential ablation target in patients with recurrent atrial fibrillation despite durable pulmonary vein isolation or in patients with roof-dependent atrial tachycardia (AT). Pulsed-field ablation (PFA) offers efficient and safe posterior wall ablation (PWA), but available data are scarce.
METHODS AND RESULTS: Consecutive patients undergoing PWA using PFA were included. Posterior wall ablation was performed using a pentaspline PFA catheter and verified by 3D-electroanatomical mapping. Follow-up was performed using 7-day Holter ECGs 3, 6, and 12 months after ablation. Recurrence of any atrial arrhythmia lasting more than 30 s was defined as failure. Lesion durability was assessed during redo procedures. Posterior wall ablation was performed in 215 patients (70% males, median age 70 [IQR 61-75] years, 67% redo procedures) and was successful in all patients (100%) by applying a median of 36 (IQR 32-44) PFA lesions. Severe adverse events were cardiac tamponade and vascular access complication in one patient each (0.9%). Median follow-up was 7.3 (IQR 5.0-11.8) months. One-year arrhythmia-free outcome in Kaplan-Meier analysis was 53%. A redo procedure was performed in 26 patients (12%) after a median of 6.9 (IQR 2.4-11) months and showed durable PWA in 22 patients (85%) with only minor lesion regression. Among four patients with posterior wall reconnection, three (75%) presented with roof-dependent AT.
CONCLUSION: Posterior wall ablation with this pentaspline PFA catheter can be safely and efficiently performed with a high durability observed during redo procedures. The added value of durable PWA for the treatment of atrial fibrillation remains to be evaluated.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology - 26(2023), 1 vom: 28. Dez. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kueffer, Thomas [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial fibrillation |
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| Anmerkungen: |
Date Completed 02.02.2024 Date Revised 02.02.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/europace/euae006 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM367157225 |
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| 100 | 1 | |a Kueffer, Thomas |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Posterior wall ablation by pulsed-field ablation |b procedural safety, efficacy, and findings on redo procedures |
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| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. | ||
| 520 | |a AIMS: The left atrial posterior wall is a potential ablation target in patients with recurrent atrial fibrillation despite durable pulmonary vein isolation or in patients with roof-dependent atrial tachycardia (AT). Pulsed-field ablation (PFA) offers efficient and safe posterior wall ablation (PWA), but available data are scarce | ||
| 520 | |a METHODS AND RESULTS: Consecutive patients undergoing PWA using PFA were included. Posterior wall ablation was performed using a pentaspline PFA catheter and verified by 3D-electroanatomical mapping. Follow-up was performed using 7-day Holter ECGs 3, 6, and 12 months after ablation. Recurrence of any atrial arrhythmia lasting more than 30 s was defined as failure. Lesion durability was assessed during redo procedures. Posterior wall ablation was performed in 215 patients (70% males, median age 70 [IQR 61-75] years, 67% redo procedures) and was successful in all patients (100%) by applying a median of 36 (IQR 32-44) PFA lesions. Severe adverse events were cardiac tamponade and vascular access complication in one patient each (0.9%). Median follow-up was 7.3 (IQR 5.0-11.8) months. One-year arrhythmia-free outcome in Kaplan-Meier analysis was 53%. A redo procedure was performed in 26 patients (12%) after a median of 6.9 (IQR 2.4-11) months and showed durable PWA in 22 patients (85%) with only minor lesion regression. Among four patients with posterior wall reconnection, three (75%) presented with roof-dependent AT | ||
| 520 | |a CONCLUSION: Posterior wall ablation with this pentaspline PFA catheter can be safely and efficiently performed with a high durability observed during redo procedures. The added value of durable PWA for the treatment of atrial fibrillation remains to be evaluated | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Posterior wall ablation | |
| 650 | 4 | |a Pulmonary vein isolation | |
| 650 | 4 | |a Pulsed-field ablation | |
| 650 | 4 | |a Reconnection | |
| 700 | 1 | |a Tanner, Hildegard |e verfasserin |4 aut | |
| 700 | 1 | |a Madaffari, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Seiler, Jens |e verfasserin |4 aut | |
| 700 | 1 | |a Haeberlin, Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Maurhofer, Jens |e verfasserin |4 aut | |
| 700 | 1 | |a Noti, Fabian |e verfasserin |4 aut | |
| 700 | 1 | |a Herrera, Claudia |e verfasserin |4 aut | |
| 700 | 1 | |a Thalmann, Gregor |e verfasserin |4 aut | |
| 700 | 1 | |a Kozhuharov, Nikola A |e verfasserin |4 aut | |
| 700 | 1 | |a Reichlin, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Roten, Laurent |e verfasserin |4 aut | |
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