Intraprocedural and outcome findings in repeat left atrial procedures after pulsed field ablation for pulmonary vein isolation in paroxysmal and persistent atrial fibrillation

• DOI: 10.1093/europace/euae102.134
• Publication Date: 2024-05-24T12:17:32Z
• Authors: J Woermann; J Jueker; J Van Den Bruck; K Filipovic; S Erlhoefer; C Scheurlen; S Dittrich; J Ackmann; F Pavel; J Schipper; D Steven; A Sultan
• Keywords: Paroxysmal atrial fibrillation; Isolation

Abstract Background Pulsed Field Ablation (PFA) has emerged as a promising novel technique for pulmonary vein isolation (PVI) in the setting of atrial fibrillation. First outcome data revealed comparable success rates to radiofrequency and cryoablation. However, on lesion dimensions reconnection PV after PFA potentially causing recurrence AF is sparse. We, therefore report pivotal sites ablation extend PFA-PVI. Methods All patients PFA-PVI paroxysmal or persistent at our center between September 2021 October 2023 were included this retrospective analysis. Baseline characteristics, procedural obtained. Furthermore, all redo procedures these occurrence location gaps evaluated. Results A total 123 with fibrillation underwent successful during index procedure. The study cohort comprised [n= 52; 42%] 71; 58%] cases. After median follow-up (IQR 93-150) days arrhythmia (all AF) occurred 9 [14. 5%] patients. Of these, 6 [9.6%] procedure due (3 PAF 3 persAF [50%]; p=1). left maps 24 PVs analyzed. [100%] exhibited electrical one more vein. Analysis that PFA-induced lesions varied among patients: right inferior (RIPV) showed redo-patients (100%). Also frequent was observed RSPV pts [50%]) LIPV (2 [33%]). gap size 66±40% circumference reconnected RPVs 61±31% LPVs. roof-line set performed 4 out (67%) initially antral affecting posterior wall LA roof creating an isthmus roof-dependent tachycardia (AT). Conclusion Outcome are other energy sources used PVI. also occurs This analysis PVI identified RIPV reconnection. map up 2/3 initial circumferential area. seems create new critical isthmuses AT. No difference seen comparing persAF.