Pulsed field ablation for atrial fibrillation with a novel simplified protocol: The PFA dose study

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-06-01 DOI:10.1016/j.hrthm.2024.11.031

Patrick Badertscher MD , Corinne Isenegger MD , Rebecca Arnet MD , Fabian Jordan MD , Sven Knecht DSc , Philipp Krisai MD , Gian Völlmin MS , Jeanne du Fay de Lavallaz MD, PhD , Josip Katic MD , David Spreen MS , Stefan Osswald MD , Christian Sticherling MD , Michael Kühne MD

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引用次数: 0

Abstract

Background

Pulsed field ablation (PFA) with use of a pentaspline catheter for the treatment of atrial fibrillation is performed in a standardized fashion. Whether a reduced number of applications results in similar clinical outcomes has not been fully investigated.

Objective

This study aimed to assess a simplified PFA dosing protocol for pulmonary vein isolation (PVI) compared with a standard protocol.

Methods

Consecutive patients undergoing their first PVI by PFA were enrolled. In the simple PFA group, patients received 4 applications per pulmonary vein (2× basket and 2× flower configuration), whereas 8 applications per pulmonary vein (4× basket and 4× flower configuration) were used in the standard PFA group.

Results

We included 245 patients (32% female; median age, 66 years), 96 (39%) in the simple PFA group and 149 (61%) in the standard PFA group. Median procedure duration, left atrial dwell time, and fluoroscopy time were significantly shorter in the simple PFA group compared with the standard PFA group at 40 (25–55) minutes vs 53 (41–67) minutes (P < .001), 22 (13–37) minutes vs 37 (27–50) minutes (P < .001), and 9 (7–12) minutes vs 11 (9–14) minutes (P < .001), respectively. First-pass isolation was similar for the simple PFA group and the standard PFA group (95% vs 95%; P > .999). Overall, 4 procedural complications were observed, all in the standard PFA group (P = .303). During a median follow-up of 373 days, freedom from atrial arrhythmias was 79% in the simple PFA group and 77% in the standard PFA group (P = .767). Findings were confirmed in comparing only patients who received PVI with or without electroanatomic mapping.

Conclusion

The novel simplified PFA protocol was associated with increased procedural efficiency while maintaining noninferior efficacy and safety compared with the standard PFA protocol.

查看原文本刊更多论文

采用新型简化方案进行心房颤动脉冲场消融：PFA 剂量研究。

背景：使用五腔导管进行脉冲场消融（PFA）治疗心房颤动（AF）是以标准化方式进行的。减少应用次数是否会带来相似的临床结果，尚未得到充分研究：评估肺静脉隔离术（PVI）的简化 PFA 给药方案与标准方案的比较。在简易 PFA 组中，患者接受 4 次应用/PV（2 次篮式和 2 次花式配置），而在标准 PFA 组中，患者接受 8 次应用/PV（4 次篮式和 4 次花式配置）：我们共纳入了 245 名患者（32% 为女性，中位年龄为 66 岁）：简单 PFA 组有 96 名患者（占 39%），标准 PFA 组有 149 名患者（占 61%）。与标准 PFA 组相比，简单 PFA 组的中位手术时间、左心房停留时间和透视时间明显缩短，分别为 40 [25-55] 分钟对 53 [41-67] 分钟（P0.999）。总体而言，共观察到 4 例手术并发症，均发生在标准 PFA 组（P=0.303）。在 373 天的中位随访期间，单纯 PFA 组和标准 PFA 组的房性心律失常发生率分别为 79% 和 77%（P=0.767）。如果只比较接受 PVI 和/或未接受 EAM 的患者，结果将得到证实：总之，与标准 PFA 方案相比，新型简化 PFA 方案提高了手术效率，同时保持了非劣质的疗效和安全性。

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

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.