Pulsed Field Ablation as First-Line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry.

Autor:	Füting A; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.).; Department of Medicine, Witten/Herdecke University, Germany (A.F., K.N., N.R.)., Neven K; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.).; Department of Medicine, Witten/Herdecke University, Germany (A.F., K.N., N.R.)., Bordignon S; Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (S. Bordignon, K.R.J.C., B. Schmidt)., Reichlin T; Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)., Blaauw Y; Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (Y.B., B.A.M.)., Hansen J; Department of Cardiology, Arrhythmia Unit, Gentofte Hospital, Copenhagen, Denmark (J.H., M.H.R.)., Adelino R; Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)., Ouss A; Department of Cardiology, Heart Center Catharina Hospital, Eindhoven, the Netherlands (A.O., P.v.d.V.)., Roten L; Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)., Mulder BA; Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands (Y.B., B.A.M.)., Ruwald MH; Department of Cardiology, Arrhythmia Unit, Gentofte Hospital, Copenhagen, Denmark (J.H., M.H.R.)., Mené R; Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)., van der Voort P; Department of Cardiology, Heart Center Catharina Hospital, Eindhoven, the Netherlands (A.O., P.v.d.V.)., Reinsch N; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany (A.F., K.N., N.R.).; Department of Medicine, Witten/Herdecke University, Germany (A.F., K.N., N.R.)., Kueffer T; Department of Cardiology, Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)., Boveda S; Heart Rhythm Department, Clinique Pasteur, Toulouse, France (R.A., R.M., S. Boveda)., Albrecht EM; Boston Scientific Corporation, St. Paul, MN (E.M.A., J.D.R., B. Sutton)., Raybuck JD; Boston Scientific Corporation, St. Paul, MN (E.M.A., J.D.R., B. Sutton)., Sutton B; Boston Scientific Corporation, St. Paul, MN (E.M.A., J.D.R., B. Sutton)., Chun KRJ; Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (S. Bordignon, K.R.J.C., B. Schmidt)., Schmidt B; Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (S. Bordignon, K.R.J.C., B. Schmidt).; Universitätsklinikum Frankfurt, Medizinische Klinik 3: Klinik für Kardiologie, Germany (B. Schmidt).
Jazyk:	angličtina
Zdroj:	Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2024 Dec; Vol. 17 (12), pp. e013088. Date of Electronic Publication: 2024 Nov 27.
DOI:	10.1161/CIRCEP.124.013088
Abstrakt:	Background: Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy. Examination of real-world data may shed light on clinical practices and the effectiveness of PFA with and without a prior history of AAD usage. Methods: European Real World Outcomes with Pulsed Field Ablation is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at 7 high-volume centers in Europe. This subanalysis evaluates patients with a history of class I/III AAD use versus those with no documented history of class I/III AAD use (first-line patients). Patients with incomplete AAD history, long-standing persistent AF, and those undergoing a repeat ablation procedure were excluded. Patients were treated and followed based on institutional standard of care. Any episode of atrial tachycardia or AF lasting longer than 30 s was considered an arrhythmia recurrence. Results: Of 1233 patients enrolled in European real world outcomes with pulsed field ablation, 1091 met the inclusion criteria (mean age, 66 years; 40% females; and persistent AF, 36%). Pulmonary vein isolation-only was used in 90% of the patients, and 10% received extra-PV ablation. Ablation as the first-line approach was chosen in 589 patients, and 502 patients had prior class I/III AAD use. In the first-line PFA group, paroxysmal AF was more frequent (68% versus 59%; P <0.001), and pulmonary vein isolation-only was more frequent (93% versus 86%; P <0.001). At 1-year follow-up, freedom from AF/atrial tachycardia recurrence was similar in the ablation-first versus the ablation after failed AAD group (78% versus 74%, respectively; P =0.076). Conclusion: In this large real-world PFA registry, freedom from AF/atrial tachycardia recurrence after 1 year was similar in patients undergoing PFA as a first-line treatment and those with prior failed AAD therapy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05823818. Competing Interests: Dr Schmidt is a consultant for and received honoraria and research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. Dr Bordignon received honoraria from Medtronic and Biosense Webster. Dr Chun is a consultant for and received honoraria and research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. Dr Bordignon is a consultant for Medtronic, Boston Scientific, Microport, and Zoll. Dr Reichlin received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation, the Swiss Heart Foundation, and the sitem-insel support fund, all for work outside the submitted study. He received speaker/consulting honoraria or travel support from Abbott/SJM, Bayer, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, Farapulse, Medtronic, and Pfizer BMS, all for work outside the submitted study. He received support for his institution’s fellowship program from Abbott/SJM, Biosense Webster, Biotronik, Boston Scientific, and Medtronic for work outside the submitted study. Dr Roten received research grants from Medtronic and speaker/consulting honoraria from Abbott and Medtronic. Dr Neven is a consultant for Biosense Webster, Boston Scientific, Field Medical, and LifeTech Scientific. Dr Füting received an educational grant from Boston Scientific. Dr Reinsch is a consultant for Boston Scientific. Dr Hansen received speaker fees from Boston Scientific and Biosense Webster. Dr Blaauw received research grants from Medtronic and AtriCure. He received speaker/consulting honoraria from Abbott/SJM and Boston Scientific, all for work outside the submitted study. Drs Albrecht and Raybuck and Dr Sutton are salaried employees of Boston Scientific. The other authors report no conflicts.
Databáze:	MEDLINE
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