TY - JOUR
T1 - A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate
T2 - Procedural data and 6-months success rates
AU - Farnir, Florent
AU - Chaldoupi, Sevasti-Maria
AU - Hermans, Ben Jm
AU - Farnir, Frédéric
AU - Habibi, Zarina
AU - Jerltorp, Kezia
AU - Verhaert, Dominique
AU - Schotten, Ulrich
AU - Maesen, Bart
AU - Vernooy, Kevin
AU - Luermans, Justin
AU - Linz, Dominik
PY - 2025/1/17
Y1 - 2025/1/17
N2 - BACKGROUND: Focal pulsed-field ablation (F-PFA) integrated in electroanatomical mapping (EAM) systems allows tailored lesion sets in patients with atrial fibrillation (AF). OBJECTIVE: To determine feasibility, safety and 6-months outcome of F-PFA for a tailored substrate-based catheter ablation (CA) approach in patients with AF and advanced atrial substrate. METHODS: Consecutive patients with AF and advanced atrial substrate treated by a F-PFA system (Cardiofocus) through contact-force sensing catheters integrated in EAM systems were prospectively enrolled. The tailored substrate-based CA approach included isolation of all pulmonary veins (PVI) with wide area circumferential ablation, posterior wall isolation (PWI), mitral anterior line and cavo-tricuspid isthmus (CTI) ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence and safety were evaluated. RESULTS: In 83 patients (33% female, indexed left atrial volume: 44±15ml/m , 80% persistent AF or atrial flutter (AFl), 57% re-do procedures), successful de-novo PVI was performed in 36 patients and PV reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low voltage areas; PWI was performed in 38 patients with low voltage areas or evoked delayed electrograms during premature atrial extrastimuli; CTI was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurrence occurred in 30/83 patients (21 AF; 9 atypical AFl). CONCLUSION: Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.
AB - BACKGROUND: Focal pulsed-field ablation (F-PFA) integrated in electroanatomical mapping (EAM) systems allows tailored lesion sets in patients with atrial fibrillation (AF). OBJECTIVE: To determine feasibility, safety and 6-months outcome of F-PFA for a tailored substrate-based catheter ablation (CA) approach in patients with AF and advanced atrial substrate. METHODS: Consecutive patients with AF and advanced atrial substrate treated by a F-PFA system (Cardiofocus) through contact-force sensing catheters integrated in EAM systems were prospectively enrolled. The tailored substrate-based CA approach included isolation of all pulmonary veins (PVI) with wide area circumferential ablation, posterior wall isolation (PWI), mitral anterior line and cavo-tricuspid isthmus (CTI) ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence and safety were evaluated. RESULTS: In 83 patients (33% female, indexed left atrial volume: 44±15ml/m , 80% persistent AF or atrial flutter (AFl), 57% re-do procedures), successful de-novo PVI was performed in 36 patients and PV reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low voltage areas; PWI was performed in 38 patients with low voltage areas or evoked delayed electrograms during premature atrial extrastimuli; CTI was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurrence occurred in 30/83 patients (21 AF; 9 atypical AFl). CONCLUSION: Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.
KW - Atrial Fibrillation
KW - First Pass Isolation
KW - Focal Ablation
KW - Posterior Wall Isolation
KW - Pulsed Field Ablation
KW - Safety
U2 - 10.1016/j.hrthm.2025.01.015
DO - 10.1016/j.hrthm.2025.01.015
M3 - Article
SN - 1547-5271
JO - Heart Rhythm
JF - Heart Rhythm
ER -