Pulsed-field- vs. cryoballoon-based pulmonary vein isolation: lessons from repeat procedures.

IF 7.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Europace Pub Date : 2024-08-30 DOI:10.1093/europace/euae221

Marc D Lemoine, Julius Obergassel, Sandro Jaeckle, Moritz Nies, Sophia Taraba, Celine Mencke, Jan Rieß, Ilaria My, Laura Rottner, Fabian Moser, Djemail Ismaili, Bruno Reißmann, Feifan Ouyang, Paulus Kirchhof, Andreas Rillig, Andreas Metzner

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引用次数: 0

Abstract

Aims: Pulsed-field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI). Initial data demonstrated high safety and efficacy. Data on long-term PVI durability and reconduction patterns in comparison to established energy sources for PVI are scarce. We compare findings in repeat ablation procedures after a first PFA to findings in repeat ablation procedures after a first cryoballoon ablation (CBA) based PVI.

Methods and result: A total of 550 consecutively enrolled patients underwent PFA or CBA index PVI. Repeat ablations in patients with symptomatic atrial arrhythmia recurrences were analysed. A total of 22/191 (12%) patients after index PFA-PVI and 44/359 (12%) after CBA-PVI underwent repeat ablation. Reconduction of any pulmonary vein (PV) was detected by multipolar spiral mapping catheter at each PV with careful evaluation of PV potentials and by 3D-mapping in 16/22 patients (73%) after PFA-PVI and in 33/44 (75%) after CBA-PVI (P = 1.000). Of 82 initially isolated PVs after PFA-PVI, 31 (38%) were reconducting; of 169 isolated PVs after CBA-PVI, 63 (37%) were reconducting (P = 0.936). Clinical atrial tachycardia occurred similarly in patients after PFA (5/22; 23%) and CBA (7/44; 16%; P = 0.515). Roof lines were set more often after PFA- (8/22; 36%) compared with CBA-PVI (5/44; 11%; P = 0.023). Repeat procedure duration [PFA: 87 (76, 123) min; CBA: 93 (75, 128) min; P = 0.446] was similar and fluoroscopy time [PFA: 11 (9, 14) min; CBA: 11 (8, 14) min; P = 0.739] equal between groups at repeat ablation.

Conclusion: During repeat ablation after previous PFA- or CBA-based PVI, electrical PV-reconduction rates and patterns were similar.

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脉冲场与冷冻球囊肺静脉隔离术：从重复手术中汲取的教训。

背景和目的：脉冲场消融（PFA）是一种新兴的肺静脉隔离（PVI）技术。初步数据显示其安全性和有效性都很高。与已有的肺静脉隔离能量来源相比，有关肺静脉隔离的长期耐久性和再传导模式的数据很少。我们比较了首次脉冲场消融（PFA）后重复消融手术的结果和首次基于低温球囊消融（CBA）的 PVI 后重复消融手术的结果。分析了有症状房性心律失常复发患者的重复消融情况：结果：共有 22/191 例（12%）PFA-PVI 指数患者和 44/359 例（12%）CBA-PVI 患者接受了重复消融术。在 PFA-PVI 后的 16/22 例患者（73%）和 CBA-PVI 后的 33/44 例患者（75%）中，通过多极螺旋测绘导管在每个肺静脉仔细评估肺静脉电位，并通过三维测绘检测到任何肺静脉（PV）的重建（P=1.000）。在 PFA-PVI 后的 82 个最初孤立的 PV 中，31 个（38%）重新传导；在 CBA-PVI 后的 169 个孤立的 PV 中，63 个（37%）重新传导（p=0.936）。临床房性心动过速在 PFA（5/22；23%）和 CBA（7/44；16%；P=0.515）术后患者中的发生率相似。与CBA-PVI（5/44；11%；P=0.023）相比，PFA-（8/22；36%）术后更常出现屋顶线。重复消融时，各组的重复手术时间（PFA：87 [76,123] 分钟；CBA：93 [75,128] 分钟；P=0.446）相似，透视时间（PFA：11 [9,14] 分钟；CBA：11 [8,14] 分钟；P=0.739）相同：结论：在进行过基于 PFA 或 CBA 的 PVI 后再次消融时，PV 电再导率和模式相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Europace 医学-心血管系统

CiteScore

10.30

自引率

8.20%

发文量

851

审稿时长

3-6 weeks

期刊介绍： EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.