Clin Res Cardiol (2022).

Pulsed Field Ablation for Substrate Modification and Atrial Tachycardia in Patients with Persistent Atrial Fibrillation – First experience.
A. Sultan1, K. Filipovic1, J. Lüker1, J. Wörmann1, J.-H. van den Bruck1, J.-H. Schipper1, C. Scheurlen1, S. Dittrich1, Z. Arica1, S. C. R. Erlhöfer1, D. Steven1
1Elektrophysiologie, Herzzentrum der Universität zu Köln, Köln;


Pulsed field ablation (PFA) a is new ablation technology to achieve pulmonary vein isolation (PVI). Recent studies provided data on feasibility and efficacy of PFA. However, only limited data is available using PFA beyond PVI for left atrial (LA) substrate modification or ablation of consecutive atrial tachycardia (AT) in patients with previous catheter ablation (CA) for persistent AF (persAF).  



To investigate feasibility and efficacy of PFA ablation beyond PVI in patients with recurrence of persAF or AT after previous CA. 



Patients (de-novo PVI and repeat ablation) underwent PFA ablation using a multispline catheter. Both available sizes (31mm and 35mm) were used. Additional 3D electro-anatomical mapping of LA was performed before and after PFA ablation to confirm PVI, characterize LA substrate, AT mechanism and ablation extent. All procedures were performed under deep analgo-sedation. 



A total of 19 consecutive patients (14 (74%) persAF, 3 (16%) PAF, 2(10%) AT) underwent PFA ablation. An index PVI was performed in 14 (74%) pts. In 5 (26%) patients PFA was performed as a Redo-procedure after previous catheter ablation. Of these 5 patients 3 (60%) suffered from recurrence of persAF and 2 (40%) presented an ongoing LA AT. In patients with persAF recurrence a posterior wall isolation and roof line was performed using PFA. Both AT were terminated immediately by PFA and an anterior line was created successfully due to AT mechanism. In all cases atrial burst-stimulation confirmed non-inducibility and 3D map showed thorough ablation of targeted areas. 

Total procedure duration was 82±17min with a fluoroscopy time of 16±4min and a dosage of 4747±2166mGy*cm2. No complications occurred acutely or during short time FU.  



Data using PFA beyond PVI is limited. This small cohort provides data indicating a favorable efficacy and feasibility of PFA for LA substrate modification and ablation of AT in patients undergoing repeat ablation. Further data is warranted to confirm these findings.