Initial experience with pulsed field ablation for atrial fibrillation.

Autor: Magni FT; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.; Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Mulder BA; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Groenveld HF; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Wiesfeld ACP; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Tieleman RG; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Cox MG; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Van Gelder IC; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Smilde T; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Tan ES; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Rienstra M; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Blaauw Y; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Jazyk: angličtina
Zdroj: Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Nov 08; Vol. 9, pp. 959186. Date of Electronic Publication: 2022 Nov 08 (Print Publication: 2022).
DOI: 10.3389/fcvm.2022.959186
Abstrakt: Introduction: Pulsed field ablation (PFA) was recently introduced for the treatment of symptomatic atrial fibrillation (AF) with the claim of selectively ablating the myocardium while sparing surrounding tissues. We present our initial experience with a PFA catheter for pulmonary vein isolation (PVI) and describe procedural findings and peri-procedural safety of the first 100 patients.
Materials and Methods: We investigated 100 patients treated for symptomatic AF using the FARAWAVE PFA catheter (Farapulse, Menlo Park, CA, USA) between July 2021 and March 2022. Procedure workflow and electrophysiological findings at the time of ablation, peri-procedural complications, and operator learning curves are described.
Results: The mean age of patients was 62.9 ± 9.4 years, 62% were male subjects and 80% had paroxysmal AF. The median CHA 2 DS 2 -VASc score was 1.5 (IQR: 1.0-2.0) and the mean left atrial volume index was 35.7 ± 9.6 ml/m2. In 88 (88%) patients, PVI alone was performed and in 12 (12%) patients additional ablation of the posterior wall was performed. 3D-electroanatomic mapping was performed in 18 (18%) patients. Procedures without mapping lasted for 52.3 ± 16.6 min. The mean number of applications per pulmonary vein (PV) was 8.1 ± 0.6. In all patients (100%), all PVs were confirmed to be isolated. The learning curves of the two operators who performed > 20 procedures showed a negligible variation of performance over time and practice did not significantly predict procedure time [Operator 1 (senior): R 2 = 0.034, p = 0.35; Operator 2 (junior): R 2 = 0.004, p = 0.73]. There was no difference between the procedure times between senior and junior operators (Operator 1: 46.9 ± 9.7 min vs. Operator 2: 45.9 ± 9.9 min; p = 0.73). The only complications observed were two cases of bleeding at the site of percutaneous access.
Conclusion: Our initial experience shows that use of the PFA catheter for pulmonary vein isolation (PVI) is safe, fast, and easy to learn.
Competing Interests: Author HG received a speaker fee from Biosense Webster. Author YB received research grants (to department) from AtriCure and Medtronic, and a speaker fee from AtriCure and Circle. He was also a proctor for Abbott, Biosense Webster, and Boston Scientific. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Magni, Mulder, Groenveld, Wiesfeld, Tieleman, Cox, Van Gelder, Smilde, Tan, Rienstra and Blaauw.)
Databáze: MEDLINE
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