Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping.

Autor:	Gunawardene MA; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany., Harloff T; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest., Jularic M; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest., Dickow J; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany., Wahedi R; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest., Anwar O; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest., Wohlmuth P; Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany., Gessler N; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany.; Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany., Hartmann J; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest., Willems S; Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.; Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany.
Jazyk:	angličtina
Zdroj:	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 [Europace] 2024 Mar 30; Vol. 26 (4).
DOI:	10.1093/europace/euae072
Abstrakt:	Aims: Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT. Methods and Results: Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P < 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11-7.65), P = 0.0473]. Conclusion: Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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