Kueffer, Thomas; Stefanova, Anita; Madaffari, Antonio; Seiler, Jens; Thalmann, Gregor; Kozhuharov, Nikola; Maurhofer, Jens; Galuszka, Oskar; Haeberlin, Andreas; Noti, Fabian; Servatius, Helge; Tanner, Hildegard; Roten, Laurent; Reichlin, Tobias (2024). Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation. Journal of interventional cardiac electrophysiology, 67(3), pp. 503-511. Springer 10.1007/s10840-023-01608-7
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BACKGROUND
A novel multipolar pulsed-field ablation (PFA) catheter has recently been introduced for pulmonary vein isolation (PVI). Pre-market data showed high rates for PVI-durability during mandatory remapping studies.
OBJECTIVE
To present post-market data in patients with recurrent arrhythmias.
METHODS
Consecutive patients undergoing a redo procedure after an index PFA PVI using a bipolar-biphasic PFA system were included. 3-D electro-anatomical maps (3D-EAM) on redo procedure were compared to the 3D-EAM acquired after ablation during the index procedure. PVI durability was assessed on a per-vein and per-patient level and the sites of reconnections were identified. Furthermore, lesion extent around veins with durable isolation was compared to study lesion regression.
RESULTS
Of 341 patients treated with a PFA PVI, 29 (8.5%) underwent a left atrial redo ablation due to arrhythmia recurrence. At the end of the index procedure, 110/112 veins (98%, four common ostia) were isolated. On redo procedures performed a median of 6 months after the first ablation, 3D-EAM identified 69/110 (63%) PVs with durable isolation. In 6 (21%) patients, all PVs were durably isolated. Reconnections were more often found on the right-sided veins and on the anterior aspects of the upper veins. Only minor lesion regression was observed between the index and redo procedure (a median of 3 mm (0 - 9.5) on the posterior wall).
CONCLUSION
In patients with arrhythmia recurrence after PFA PVI using a first-generation PFA device, durable isolation was observed in 63% of the veins and 21% of the patients showed durable isolation of all previously isolated veins.
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