Safety and effectiveness of pulsed field ablation for pulmonary vein isolation in atrial fibrillation patients: One-year single center experience.

Abstract

Introduction and objectives: Pulmonary vein (PV) isolation is one of the cornerstones of rhythm-control therapy for symptomatic atrial fibrillation (AF) patients. Pulsed field ablation (PFA) is a novel ablation modality that involves the application of electrical pulses causing cellular death, and it has preferential tissue specificity. In this study, we aimed to share a one-year single center experience of AF ablation with PFA.

Methods: Single center, retrospective study of consecutive patients undergoing PVI using the pentaspline PFA catheter between June 2022 and July 2023. Data on demographic, procedural, and electrocardiographic recurrence (assessed after a three-month blanking period) were analyzed.

Results: One hundred twenty-three consecutive patients were included (62±11 years, 59% male), with a mean CHA₂DS₂-VASc score of 2±1 points, median left ventricular ejection fraction of 61% [IQR 60-65%] and a median left atrial volume index (by CT scan) of 55 mL/m² [IQR 41-67 mL/m²]. Fifty-two percent of patients presented paroxysmal AF and 21 patients (17%) underwent a redo ablation. Median procedure time was 83 min [IQR 59-117 min] and median fluoroscopy time was 11.6 min [IQR 8.2-15.6 min]; posterior wall isolation was performed in 43 (35%). Two patients (1.6%) experienced acute cardiac tamponade, immediately treated with pericardiocentesis. Other complications were primarily vascular, in 4% of cases (three femoral hematomas, one femoral pseudoaneurysms, one arteriovenous fistula). Over 290 (IQR 169-387) days of follow-up, considering electrocardiographic recurrence beyond the blanking period, 9% of patients had AF recurrence (two with paroxysmal AF and nine with persistent AF).

Conclusions: Pulsed field ablation for PVI and posterior wall ablation was an efficient and safe procedure with low rate of complications and high percentage of patients were free from AF in short-term follow-up. We need more studies to evaluate long-term success.