Feasibility and Safety of Pulsed-Field Ablation for Persistent Atrial Fibrillation: A Prospective Study.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Pace-Pacing and Clinical Electrophysiology Pub Date : 2025-03-01 Epub Date: 2025-02-06 DOI:10.1111/pace.15162

Guocai Chen, Mingyang Gao, Yiwei Lai, Lihong Huang, Shijun Xia, Song Zuo, Xueyuan Guo, Nian Liu, Deyong Long, Jianzeng Dong, Liu He, Xin Du, Songnan Li, Caihua Sang, Changsheng Ma

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引用次数: 0

Abstract

Introduction: Pulsed-field ablation (PFA) is a novel nonthermal ablation approach using rapid electrical pulses to cause cardiac cell apoptosis via electroporation. Our study aims to investigate the feasibility and safety of PFA for persistent atrial fibrillation (PeAF).

Methods: Thirty-two consecutive patients diagnosed with PeAF were enrolled in our study. All patients underwent PFA treatment using the strategy including pulmonary vein isolation (PVI), left atrial posterior wall (LAPW) isolation, cavotricuspid isthmus (CTI) block, and mitral isthmus (MI) block. Acute and follow-up procedure outcomes were evaluated, and adverse events related to the ablation procedure were also observed.

Results: One-year survival free from atrial tachyarrhythmia post-ablation was 65.6%. Acute success rates for PVI, LAPW isolation, CTI block, and MI block were 100%, 100%, 96.9%, and 81.3%, respectively. Eleven cases (34.4%) experienced atrial tachyarrhythmia recurrence, with eight cases being atrial fibrillation (AF) recurrence and three cases being atrial flutter recurrence. Three patients underwent repeat ablation. Minor complications were encountered in four patients with asymptomatic cerebral lesions. Vagal responses were commonly observed during the procedure. No severe coronary vasospasm or severe hemolysis occurred in our cohort.

Conclusion: PFA with the strategy including PVI, LAPW isolation, CTI block, and MI block is feasible, safe, and associated with a high rate of freedom from atrial tachyarrhythmia recurrence at 1 year in patients with PeAF.

Trial registration: This study registered at the Chinese Clinical Trial Registry (ChiCTR2300068980).

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脉冲场消融治疗持续性心房颤动的可行性和安全性：一项前瞻性研究。

简介：脉冲场消融（PFA）是一种新型的非热消融方法，利用快速电脉冲通过电穿孔引起心肌细胞凋亡。本研究旨在探讨PFA治疗持续性心房颤动（PeAF）的可行性和安全性。方法：32例连续诊断为PeAF的患者纳入我们的研究。所有患者均采用肺静脉隔离（PVI）、左心房后壁（LAPW）隔离、颈三尖瓣峡（CTI）阻断和二尖瓣峡（MI）阻断等策略进行PFA治疗。评估急性和随访过程的结果，并观察与消融过程相关的不良事件。结果：消融后无房性心动过速的一年生存率为65.6%。PVI、LAPW隔离、CTI阻断和MI阻断的急性成功率分别为100%、100%、96.9%和81.3%。11例（34.4%）心房心动过速复发，其中房颤复发8例，心房扑动复发3例。3例患者接受了重复消融。4例无症状脑损伤患者出现轻微并发症。在手术过程中通常观察到迷走神经反应。在我们的队列中没有发生严重的冠状血管痉挛或严重的溶血。结论：PFA联合PVI、LAPW隔离、CTI阻断和MI阻断是可行、安全的，PeAF患者1年房性心动过速复发率高。试验注册：本研究已在中国临床试验注册中心注册（ChiCTR2300068980）。

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

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.