Intracardiac echocardiography–guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience

Dello Russo, Antonio; Tondo, Claudio; Schillaci, Vincenzo; Casella, Michela; Iacopino, Saverio; Bianchi, Stefano; Fassini, Gaetano; Rossillo, Antonio; Compagnucci, Paolo; Schiavone, Marco; Salito, Armando; Maggio, Ruggero; Cipolletta, Laura; Themistoclakis, Sakis; Pandozi, Claudio; Filannino, Pasquale; Rossi, Pietro; Bonanno, Carlo; Parisi, Quintino; Malacrida, Maurizio; Solimene, Francesco

doi:10.1007/s10840-023-01699-2

Cited by 7 publications

(2 citation statements)

References 19 publications

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“…However, reported by Russo et al, PFA can be executed with consistent speed, security, and efficacy. Employing ICE for guidance during PVI did not demonstrate an enhancement in procedural metrics ( 11 ).…”

Section: Discussionmentioning

confidence: 98%

Radiofrequency catheter ablation for re-do procedure after single-shot pulmonary vein isolation with pulsed field ablation for paroxysmal atrial fibrillation: case report

Yang,

Lin,

Zhang

et al. 2024

Front. Cardiovasc. Med.

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BackgroundCatheter ablation is frequently used to manage recurrent atrial fibrillation (AF) resistant to drug therapy, with pulmonary vein isolation (PVI) as a key tactic. Pulsed field ablation (PFA) has emerged as an innovative technology for PVI but poses challenges for redo procedures.Case presentationWe report on a 73-year-old female patient who experienced recurrent AF after initial successful PVI using a novel PFA technology and subsequently underwent radiofrequency catheter ablation during a repeat intervention. The reconnection of pulmonary veins was discovered primarily in the anterior region of the right superior PV and the superior portion of the left superior PV. An anatomically-based segmental approach and larger circumferential PVI, followed by additional linear ablations at non-PV trigger sites, proved decisive in preventing further recurrence of atrial tachycardia.ConclusionWhile PFA exhibits promise as a secure and efficient modality for PVI, it necessitates excellent contact quality to ensure lasting results. For patients experiencing AF recurrences post-PFI, expanded strategies incorporating both comprehensive PVI and linear ablations at targeted non-PV sites might enhance treatment outcomes.

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Section: Discussionmentioning

confidence: 98%

Radiofrequency catheter ablation for re-do procedure after single-shot pulmonary vein isolation with pulsed field ablation for paroxysmal atrial fibrillation: case report

Yang,

Lin,

Zhang

et al. 2024

Front. Cardiovasc. Med.

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“…In our patient cohort, intracardiac echocardiography (ICE) was not utilized in any of the instances. Recent research [17] has shown that while ICE may not offer significant advantages in procedural parameters, it remains an intriguing tool for enhancing safety, visualizing anatomical structures of the LA, and ensuring tissue contact during ablation procedures. Integrating ICE with 3D-EAM and PFA could potentially offer synergistic benefits, particularly in complex cases where precise visualization and catheter manipulation are crucial.…”

Section: Discussionmentioning

confidence: 99%

Procedural efficiency is enhanced combining the pentaspline pulsed field ablation catheter with three-dimensional electroanatomical mapping system for pulmonary vein isolation

Falasca Zamponi,

Olson,

Scheel

et al. 2024

J Interv Card Electrophysiol

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Background Pulsed field ablation (PFA) offers a safe, non-thermal alternative for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Currently, the pentaspline PFA-system relies heavily on fluoroscopy for catheter manipulation, which poses challenges due to the complexity of left atrium anatomy. Incorporating three-dimensional electroanatomical mapping (3D-EAM) could improve procedural efficiency reducing dependency on fluoroscopy guidance. This study aims to evaluate the effects of integration of 3D-EAM with PFA during PVI. Methods Between September 2022 and December 2023, we retrospectively enrolled 248 patients with paroxysmal or persistent AF undergoing PVI at our center using the pentaspline PFA catheter. The control group (n = 104) received conventional PFA with fluoroscopic guidance alone, while the intervention group (n = 144) underwent PVI with PFA with 3D-EAM integration. Primary outcomes were procedural time, fluoroscopy time (FT), and dose area product (DAP). Secondary endpoints included acute procedural success and incidence of periprocedural complications. Results In the 3D-EAM-PFA group, procedural time was 63.3 ± 14.3 min, compared to 65.6 ± 14.9 min in the control group (p = 0.22). The 3D-EAM group experienced significantly reduced FT (9.7 ± 4.4 min vs. 16.7 ± 5.2 min) and DAP (119.2 ± 121.7 cGycm2 vs. 338.7 ± 229.9 cGycm2) compared to the control group, respectively (p < 0.001). Acute procedural success was achieved in all cases. No major complications were observed in either group. Conclusion Integration of 3D-EAM with the pentaspline PFA catheter for PVI in AF treatment offers a promising approach, with significantly reduced fluoroscopy exposure without compromising procedural time and efficacy. Graphical abstract

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In PFA for atrial fibrillation, not time to sing ICE ICE baby…yet

Alyesh,

Palmeri,

Choe

et al. 2024

J Interv Card Electrophysiol

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Intracardiac echocardiography–guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience

Cited by 7 publications

References 19 publications

Radiofrequency catheter ablation for re-do procedure after single-shot pulmonary vein isolation with pulsed field ablation for paroxysmal atrial fibrillation: case report

Radiofrequency catheter ablation for re-do procedure after single-shot pulmonary vein isolation with pulsed field ablation for paroxysmal atrial fibrillation: case report

Procedural efficiency is enhanced combining the pentaspline pulsed field ablation catheter with three-dimensional electroanatomical mapping system for pulmonary vein isolation

In PFA for atrial fibrillation, not time to sing ICE ICE baby…yet

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