Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation.

Turagam, Mohit K; Neuzil, Petr; Schmidt, Boris; Reichlin, Tobias; Neven, Kars; Metzner, Andreas; Hansen, Jim; Blaauw, Yuri; Maury, Philippe; Arentz, Thomas; Sommer, Philipp; Anic, Ante; Anselme, Frederic; Boveda, Serge; Deneke, Tom; Willems, Stephan; van der Voort, Pepijn; Tilz, Roland; Funasako, Moritoshi; Scherr, Daniel; ... (2024). Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation. JACC Clinical electrophysiology, 10(5), pp. 900-912. Elsevier 10.1016/j.jacep.2024.01.017

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BACKGROUND

Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury.

OBJECTIVES

This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA).

METHODS

In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events.

RESULTS

Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51).

CONCLUSIONS

In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman, Roten, Laurent, Kueffer, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2405-5018

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

05 Mar 2024 08:05

Last Modified:

31 May 2024 00:13

Publisher DOI:

10.1016/j.jacep.2024.01.017

PubMed ID:

38430087

Uncontrolled Keywords:

atrial fibrillation posterior wall ablation pulmonary vein isolation pulsed field ablation

BORIS DOI:

10.48350/193732

URI:

https://boris.unibe.ch/id/eprint/193732

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