Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w |
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Pulsed-field vs. cryoballoon-based pulmonary vein isolation: Lessons from repeat procedures | ||
M. Lemoine1, J. Obergassel1, L. Rottner1, F. Moser1, I. My1, J. Wenzel1, J. Moser1, B. Reißmann1, F. Ouyang1, P. Kirchhof1, A. Rillig1, A. Metzner1 | ||
1Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; | ||
Background: Pulsed-field ablation (PFA) integrated into a pentaspline catheter is a novel single shot device to perform pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF). While initial data demonstrated high safety and efficacy, long-term PVI durability and reconnection patterns are unknown. Here, we analyzed findings from repeat ablation procedures after index PFA compared to cryoballoon ablation (CBA) based PVI.
Methods: We prospectively included consecutive patients with index PVI applying PFA (n=161) or CBA (n=302) who underwent repeat ablation due to symptomatic recurrence of AF or atrial tachycardia (AT) after a blanking period of 3 months. All repeat procedures were performed with a 3D mapping system and RF energy.
Results: We identified a total of 14 patients after previous PFA and 23 patients after previous CBA. PV reconnection was detected in 9/14 (64%) patients after PFA and in 16/23 (70%) after CBA (p=1.000). A total of 24/55 (44%) vs. 34/92 (37%, p=0.487) initially isolated PVs demonstrated electrical reconduction after PFA and CB ablation. In both groups the right inferior PV was reconnected most frequently (9/24 (38%) patients after PFA and 10/34 (29%; p=0.578) patients after CBA. Distribution of conduction gaps is shown in figure 1. All PVs were successfully reisolated. Repeat procedures after index PFA and CBA showed similar duration (115±32 min vs. 114±49 min; p=0.785), fluoroscopy time (13±4 min vs. 14±8 min; p=0.558) and number of RF applications (38±23 vs. 36±34, p=0.738).
Conclusion: During repeat AF/AT ablation after previous PFA- or CBA-based PVI a comparable incidence of PV reconduction gaps was found. Repeat procedure times and fluoroscopy exposure were similar. Randomized controlled trials and longer follow-up are necessary to draw further conclusions.
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https://dgk.org/kongress_programme/jt2023/aP1283.html |