PURPOSE: Pulsed-field ablation (PFA) is a new energy source to achieve pulmonary vein isolation (PVI) by targeted electroporation of cardiomyocytes. Experimental and controlled clinical trial data suggest good efficacy of PFA-based PVI. We aimed to assess efficacy, safety and follow-up of PFA-based PVI in an early adopter routine care setting. METHODS: Consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) underwent PVI using the Farawave® PFA ablation catheter in conjunction with three-dimensional mapping at two German high-volume ablation centers. PVI was achieved by applying 8 PFA applications in each PV. RESULTS: A total of 138 patients undergoing a first PVI (67 ± 12 years, 66% male, 62% persistent AF) were treated. PVI was achieved in all patients by deploying 4563 applications in 546 PVs (8.4 ± 1.0/PV). Disappearance of PV signals after the first application was demonstrated in 544/546 PVs (99.6%). More than eight PFA applications were performed in 29/546 PVs (6%) following adapted catheter positioning or due to reconnection as assessed during remapping. Mean procedure time was 78 ± 22 min including pre- and post PVI high-density voltage mapping. PFA catheter LA dwell-time was 23 ± 9 min. Total fluoroscopy time and dose area product were 16 ± 7 min and 505 [275;747] cGy*cm2. One pericardial tamponade (0.7%), one transient ST-elevation (0.7%) and three groin complications (2.2%) occurred. 1-year follow-up showed freedom of arrhythmia in 90% in patients with paroxysmal AF (n = 47) and 60% in patients with persistent AF (n = 82, p = 0.015). CONCLUSIONS: PFA-based PVI is acutely highly effective and associated with a beneficial safety and low recurrence rate.
PURPOSE: Pulsed-field ablation (PFA) is a new energy source to achieve pulmonary vein isolation (PVI) by targeted electroporation of cardiomyocytes. Experimental and controlled clinical trial data suggest good efficacy of PFA-based PVI. We aimed to assess efficacy, safety and follow-up of PFA-based PVI in an early adopter routine care setting. METHODS: Consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) underwent PVI using the Farawave® PFA ablation catheter in conjunction with three-dimensional mapping at two German high-volume ablation centers. PVI was achieved by applying 8 PFA applications in each PV. RESULTS: A total of 138 patients undergoing a first PVI (67 ± 12 years, 66% male, 62% persistent AF) were treated. PVI was achieved in all patients by deploying 4563 applications in 546 PVs (8.4 ± 1.0/PV). Disappearance of PV signals after the first application was demonstrated in 544/546 PVs (99.6%). More than eight PFA applications were performed in 29/546 PVs (6%) following adapted catheter positioning or due to reconnection as assessed during remapping. Mean procedure time was 78 ± 22 min including pre- and post PVI high-density voltage mapping. PFA catheter LA dwell-time was 23 ± 9 min. Total fluoroscopy time and dose area product were 16 ± 7 min and 505 [275;747] cGy*cm2. One pericardial tamponade (0.7%), one transient ST-elevation (0.7%) and three groin complications (2.2%) occurred. 1-year follow-up showed freedom of arrhythmia in 90% in patients with paroxysmal AF (n = 47) and 60% in patients with persistent AF (n = 82, p = 0.015). CONCLUSIONS: PFA-based PVI is acutely highly effective and associated with a beneficial safety and low recurrence rate.
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Authors: Karl-Heinz Kuck; Josep Brugada; Alexander Fürnkranz; Andreas Metzner; Feifan Ouyang; K R Julian Chun; Arif Elvan; Thomas Arentz; Kurt Bestehorn; Stuart J Pocock; Jean-Paul Albenque; Claudio Tondo Journal: N Engl J Med Date: 2016-04-04 Impact factor: 91.245
Authors: Jacob S Koruth; Kenji Kuroki; Iwanari Kawamura; Richard Brose; Raju Viswanathan; Eric D Buck; Elina Donskoy; Petr Neuzil; Srinivas R Dukkipati; Vivek Y Reddy Journal: Circ Arrhythm Electrophysiol Date: 2020-01-24
Authors: Iwanari Kawamura; Petr Neuzil; Poojita Shivamurthy; Kenji Kuroki; Jeff Lam; Daniel Musikantow; Edward Chu; Mohit K Turagam; Kentro Minami; Moritoshi Funasako; Jan Petru; Subbarao Choudry; Marc A Miller; Marie-Noelle Langan; William Whang; Srinivas R Dukkipati; Jacob S Koruth; Vivek Y Reddy Journal: Europace Date: 2021-11-08 Impact factor: 5.214