Christian Blockhaus1,2, Jan-Erik Guelker3,4, Ludger Feyen3,5,6, Alexander Bufe7,3, Melchior Seyfarth3,8, Dong-In Shin7,3. 1. Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Lutherplatz 40, 47805, Krefeld, Germany. christian.blockhaus@helios-gesundheit.de. 2. Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany. christian.blockhaus@helios-gesundheit.de. 3. Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany. 4. Department of Cardiology, Petrus Hospital, 42283, Wuppertal, Germany. 5. Department of Diagnostic and Interventional Radiology, Helios Clinic Krefeld, 47805, Krefeld, Germany. 6. Department of Diagnostic and Interventional Radiology, Helios University Hospital, 42283, Wuppertal, Germany. 7. Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Lutherplatz 40, 47805, Krefeld, Germany. 8. Department of Cardiology, Helios University Hospital, 42283, Wuppertal, Germany.
Abstract
BACKGROUND: Pulsed field ablation (PFA) is a new, non-thermal technology in the treatment of atrial fibrillation (AF). Early investigations have shown a promising safety profile with durable pulmonary vein isolation (PVI) and large antral lesions. However, clinical data remains scarce. METHODS: We investigated a cohort of 43 patients. Twenty-three patients underwent PVI with PFA in our hospital and we analyzed them with regard to procedural characteristics and with regard to the size of acute antral lesion which was estimated by using an electroanatomical map of the left atrium (LA). We compared these data with data of 20 patients who had undergone cryoballon (CB) PVI in our hospital. RESULTS: We could show acute isolation of all veins in all patients (100% PFA, 100% CB). Post-ablation high-density mapping revealed no early reconnection (0%). The acute antral lesion size of PFA was significantly higher compared to the CB (67.03 ± 12.69% vs. 57.39 ± 10.91%, p = 0.01). In the PFA group, we found no acute phrenic nerve injury, no major or minor bleeding, and no tamponade but one (4.34%) patient suffered from a stroke. Transient hypotension was observed frequently as well as transient bradycardia or asystole episodes requiring right ventricular pacing. In the CB group, no complications occurred. Furthermore, we discuss practical issues on PFA procedures. CONCLUSIONS: PFA is a promising technology with high acute PV isolation rate and large antral lesions compared to CB. However, larger trials with more patients and data on long-term freedom of AF but also complications are needed.
BACKGROUND: Pulsed field ablation (PFA) is a new, non-thermal technology in the treatment of atrial fibrillation (AF). Early investigations have shown a promising safety profile with durable pulmonary vein isolation (PVI) and large antral lesions. However, clinical data remains scarce. METHODS: We investigated a cohort of 43 patients. Twenty-three patients underwent PVI with PFA in our hospital and we analyzed them with regard to procedural characteristics and with regard to the size of acute antral lesion which was estimated by using an electroanatomical map of the left atrium (LA). We compared these data with data of 20 patients who had undergone cryoballon (CB) PVI in our hospital. RESULTS: We could show acute isolation of all veins in all patients (100% PFA, 100% CB). Post-ablation high-density mapping revealed no early reconnection (0%). The acute antral lesion size of PFA was significantly higher compared to the CB (67.03 ± 12.69% vs. 57.39 ± 10.91%, p = 0.01). In the PFA group, we found no acute phrenic nerve injury, no major or minor bleeding, and no tamponade but one (4.34%) patient suffered from a stroke. Transient hypotension was observed frequently as well as transient bradycardia or asystole episodes requiring right ventricular pacing. In the CB group, no complications occurred. Furthermore, we discuss practical issues on PFA procedures. CONCLUSIONS: PFA is a promising technology with high acute PV isolation rate and large antral lesions compared to CB. However, larger trials with more patients and data on long-term freedom of AF but also complications are needed.
Authors: Riccardo Proietti; Pasquale Santangeli; Luigi Di Biase; Jacqueline Joza; Martin Louis Bernier; Yang Wang; Antonio Sagone; Maurizio Viecca; Vidal Essebag; Andrea Natale Journal: Circ Arrhythm Electrophysiol Date: 2014-01-02
Authors: Vivek Y Reddy; Petr Neuzil; Jacob S Koruth; Jan Petru; Moritoshi Funosako; Hubert Cochet; Lucie Sediva; Milan Chovanec; Srinivas R Dukkipati; Pierre Jais Journal: J Am Coll Cardiol Date: 2019-05-11 Impact factor: 24.094
Authors: David N Kenigsberg; Natalia Martin; Hae W Lim; Marcin Kowalski; Kenneth A Ellenbogen Journal: Heart Rhythm Date: 2014-11-13 Impact factor: 6.343
Authors: Vivek Y Reddy; Srinivas R Dukkipati; Petr Neuzil; Ante Anic; Jan Petru; Moritoshi Funasako; Hubert Cochet; Kentaro Minami; Toni Breskovic; Ivan Sikiric; Lucie Sediva; Milan Chovanec; Jacob Koruth; Pierre Jais Journal: JACC Clin Electrophysiol Date: 2021-04-28
Authors: Atul Verma; Lucas Boersma; David E Haines; Andrea Natale; Francis E Marchlinski; Prashanthan Sanders; Hugh Calkins; Douglas L Packer; John Hummel; Birce Onal; Sofi Rosen; Karl-Heinz Kuck; Gerhard Hindricks; Bradley Wilsmore Journal: Circ Arrhythm Electrophysiol Date: 2021-12-29
Authors: Hubert Cochet; Yosuke Nakatani; Soumaya Sridi-Cheniti; Ghassen Cheniti; F Daniel Ramirez; Takashi Nakashima; Charles Eggert; Christopher Schneider; Raju Viswanathan; Nicolas Derval; Josselin Duchateau; Thomas Pambrun; Remi Chauvel; Vivek Y Reddy; Michel Montaudon; François Laurent; Frederic Sacher; Mélèze Hocini; Michel Haïssaguerre; Pierre Jais Journal: Europace Date: 2021-05-07 Impact factor: 5.214
Authors: Brian Howard; David E Haines; Atul Verma; Douglas Packer; Nicole Kirchhof; Noah Barka; Birce Onal; Steve Fraasch; Damijan Miklavčič; Mark T Stewart Journal: Circ Arrhythm Electrophysiol Date: 2020-07-27