Focal pulsed field ablation for organised atrial tachyarrhythmias: one to rule them all

• DOI: 10.1093/europace/euae102.816
• Publication Date: 2024-05-24T12:34:35Z
• Authors: I Sikiric; Z Jurisic; T Breskovic; L Lisica; M Dagelic; J Katic; A Anic
• Keywords: Atrial tachycardia

Abstract Background Focal pulsed field ablation (fPFA) has emerged as a versatile and innovative strategy for ablating atrial tachyarrhythmias (1). The primary objective of this study is to present the short-term safety characteristics, feasibility procedural outcomes fPFA in management organised tachyarrhythmias. This report focuses on commercial use an (PFA) generator, utilized conjunction with commercially available focal, solid-tip catheters, complemented by 3D electro-anatomical mapping (3D-EAM). Methods Patients tachycardia treated using between August 2022 September 2023 at our center were included retrospective analysis. Tachycardia mechanisms identified high-definition, multi-electrode catheter paired 3D-EAM system. Ablation lines, when targeting macro-reentrant arrhythmias strategicaly positioned adress critical isthmi recognised or they empirically placed anatomical obstacles ( including LA roof, anterior, mitral isthmus, upper septal cavotricuspid line deemed appropriate). Positioning was guided 3D-EAM, intracardiac ultrasound, fluoroscopy (Figure 1). Bidirectional block verification performed standard criteria assess acute success. Glyceryl trinitrate boluses administered prior proximity coronary arteries. Results In cohort 36 patients (median age 62 years; 12 females), we effectively mapped total 51 distinct These 18 typical flutters, 3 roof-dependent macro-reentries, 4 posterior-wall micro-reentries, 15 peri-mitral 8 anterior-wall micro-reentries biatrial macro-reentries via Bachman bundle. Our involved creating 21 isthmus roof posterior wall 11 anterior lines 2). Impressively, first-pass isolation bidirectional achieved 93% (54 58) ablations 94% (17 18) left lines. No ST segment alterations other complications observed during periprocedural period. Conclusion proved feasible, effective, safe approach treating tacharrhythmias. reason designating setup preferred choice redo procedures lies its versatility addressing wide range arrhythmias. As ultra-fast pulmonary vein (PVI) become more prevalent expansion PFA, demand ideal capable various substrates will even pronounced (2). Notably, findings suggest superior suitability efficacy compared bulkier, single-shot design PFA devices (3).Figure 1Figure 2