Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9 |
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First insights of pulsed-field ablation based pulmonary vein isolation: a real world single-center experience | ||
M. Lemoine1, R. Schleberger1, P. Münkler1, F. Moser2, J. Moser1, L. Rottner2, L. Dinshaw1, F. Ouyang2, B. Reissmann2, P. Kirchhof2, A. Rillig1, A. Metzner1 | ||
1Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; | ||
Background: Pulsed-field ablation (PFA) is a new energy source to perform pulmonary vein isolation (PVI) by targeted electroporation of cardiomyocytes. This new energy source, integrated into a single-shot PVI device, has the potential to increase efficacy and safety of PVI compared to thermal energy sources. Aim: To assess feasibility, efficacy and safety of PFA. Methods: Consecutive patients with symptomatic, drug-refractory paroxysmal or persistent atrial fibrillation (AF) underwent PVI using the PFA ablation catheter (Farawave®, Farapulse Inc, Menlo Park, CA, USA,). The left atrium was accessed by a single transseptal puncture and PVs were located by selective PV angiographies. Applications were performed first in a basket-configuration followed by a “flower” configuration 2 times in 2 positions each with 1900 or 2000 V. 3D voltage mapping of the left atrium was performed before and after PVI. Results: A total of 31 patients (mean age 66±2 years, 21 (68%) males, 18 (58%) persistent AF) were included. PVI was achieved in all patients (31/31) by deploying 1040 applications in 124 PV. Isolation after the first of eight applications was demonstrated in 115/124 PVs (93%). More than eight applications were performed in 7 PVs, achieving acute PVI (3x right superior PV, 2x right inferior PV, 1x left superior PV, 1x left inferior PV). After remapping revealed PV reconnections of 2 right inferior PVs, 8 additional applications were performed. In one patient additional isolation of the vena cava superior was done due to premature beats triggering AF. Mean procedure and LA PF catheter dwell-time was 96±4 and 29±2 min, while total fluoroscopy time was 21.8±2.1 min and dose area product of 1023±176 cGycm². No major complication occurred..
Conclusion: In the first analysis, all identified PVs were successfully isolated using the farapulse catheter without major complications. |
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https://dgk.org/kongress_programme/ht2021/P170.htm |