Left atrial posterior wall isolation using pulsed-field ablation: procedural characteristics, safety, and mid-term outcomes

Abstract

Background Non-pulmonary vein (PV) ablation targets such as posterior wall isolation (PWI) have been tested in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) offers a novel ablation technology possibly able to overcome the obstacles of incomplete PWI and concerns of damage to adjacent structures compared to thermal energy sources. Our aim was to assess procedural characteristics, safety, and mid-term outcomes of patients undergoing PWI using PFA in a clinical setting. Methods Patients undergoing PFA-PVI with PWI were included. First-pass isolation was controlled using a multipolar mapping catheter. Results One hundred consecutive patients were included (median age 69 [IQR 63–75] years, 33 females (33%), left atrial size 43 [IQR 39–47] mm, paroxysmal AF 24%). Median procedure time was 66 (IQR 59–77) min, and fluoroscopy time was 11 (8–14) min. PWI using PFA was achieved in 100% of patients with a median of 19 applications (IQR 14–26). There were no major complications. Overall, in 15 patients (15%), recurrent AF/AT was noted during a median follow-up of 144 (94–279) days. Conclusions PWI using PFA appears safe and results in high acute isolation rates and high arrhythmia survival during mid-term follow-up. Further randomized trials are essential and warranted. Graphical abstract

Safety and effectiveness of additional left atrial posterior wall ablation using pulsed field ablation for persistent and long‐standing persistent atrial fibrillation patients

“…10,11,27 Recent studies also confirmed the safety and feasibility of PFA PVI + PWA. 15,16,18,19 A meta-analysis of posterior wall isolation via RF revealed 15 major complications, including 2 atrioesophageal fistulas, while none of the patients in this study experienced any esophageal complications even after extensive ablation. 28 Importantly, none of the patients in this study had adverse events that could be attributed to prolonged ablation time, especially with a median LAPW PFA time of 8 min.…”

“…15,16 The latest meta-analysis comparing PVI with PVI + LAPW ablation in PerAF patients reported higher rates of arrhythmia freedom and reduced recurrence of overall atrial tachyarrhythmia in the PVI + LAPW group, even thoughGunawardene et al and Turagam et al …”

The Yin and Yang of the persistent atrial fibrillation catheter ablation: Posterior wall isolation and novel pulsed field ablation technology

“…The feasibility, rapidity, durability, and safety of the multispline PFA catheter alone (flat "flower" configuration rather than focal catheter) among PeAF patients (n = 25) for ICE-guided PVI+LAPWI were demonstrated by Reddy et al in a preliminary small-sized study (PersAFOne). 14 Badertscher et al 18 showed that PFA-based PVI plus LAPWI (indication and endpoint based on 3D-EAM) was achieved in 100 patients (76% PeAF) at a median of 66 min and 16 (12-20) PFA lesions without any major complication and a 15% recurrence rate at 144 (94-279) days follow-up. They performed two anchor lesions per vein extending to LAPW, then the wire was pulled back and the PFA catheter was rotated along the entire LAPW in a flower configuration in an overlapping fashion which revealed a 95% first-pass isolation rate.…”