Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

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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