Maurhofer, Jens; Tanner, Hildegard; Kueffer, Thomas; Madaffari, Antonio; Thalmann, Gregor; Kozhuharov, Nikola; Galuszka, Oskar; Servatius, Helge; Haeberlin, Andreas; Noti, Fabian; Roten, Laurent; Reichlin, Tobias (2024). Pulsed-field ablation for repeat procedures after failed prior thermal ablation for atrial fibrillation. Heart rhythm O2, 5(5), pp. 257-265. Elsevier 10.1016/j.hroo.2024.03.012
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BACKGROUND
Pulsed-field ablation (PFA) is a novel nonthermal ablation technology. Its potential value for repeat procedures after unsuccessful thermal ablation for atrial fibrillation has not been assessed.
OBJECTIVE
The purpose of this study was to summarize our initial experience with patients undergoing repeat procedures using PFA.
METHODS
Consecutive patients with arrhythmia recurrences after a prior thermal ablation undergoing a repeat procedure using a multipolar PFA catheter from May 2021 and December 2022 were included. After 3-dimensional electroanatomic mapping, reconnected pulmonary veins (PVs) were reisolated and veins with only ostial isolation wither ablated to widen antral PV isolation. Posterior wall ablation was performed if all PVs were durably isolated or in case of low-voltage areas on the posterior wall at the discretion of the operator. Patients underwent follow-up with 7-day Holter electrocardiography after 3, 6, and 12 months.
RESULTS
A total of 186 patients undergoing a repeat procedure using PFA were included. The median number of previous ablations was 1 (range 1-6). The prior ablation modality was radiofrequency in 129 patients (69.4%), cryoballoon in 51 (27.4%), and epicardial ablation in 6 (3.2%). At the beginning of the procedure, 258 of 744 PVs (35%) showed reconnections. Additional antral ablations were applied in 236 of 486 still isolated veins (49%). Posterior wall ablation was added in 125 patients (67%). Major complications occurred in 1 patient (transient ischemic attack 0.5%). Freedom from arrhythmia recurrence in Kaplan-Meier-analysis was 78% after 6 months and 54% after 12 months.
CONCLUSION
PFA is a versatile and safe option for repeat procedures after failed prior thermal ablation.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Maurhofer, Jens Rudolf, Tanner, Hildegard, Kueffer, Thomas, Madaffari, Antonio, Thalmann, Gregor, Kozhuharov, Nikola Asenov, Galuszka, Oskar Marian, Servatius, Helge Simon (B), Häberlin, Andreas David Heinrich, Noti, Fabian, Roten, Laurent, Reichlin, Tobias Roman |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2666-5018 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
12 Jun 2024 09:07 |
Last Modified: |
13 Jun 2024 21:16 |
Publisher DOI: |
10.1016/j.hroo.2024.03.012 |
PubMed ID: |
38840763 |
Uncontrolled Keywords: |
Atrial fibrillation Cryoballoon ablation Pulmonary vein isolation Pulsed-field ablation Radiofrequency ablation Repeat procedure |
BORIS DOI: |
10.48350/197644 |
URI: |
https://boris.unibe.ch/id/eprint/197644 |
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