PVI Durability After PFA or RFA in Persistent-AF

IF 7.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2026-10-01 Epub Date: 2026-06-25 DOI:10.1016/j.jacep.2026.04.027

Oskar M. Galuszka MD, Thomas Kueffer PhD, Samuel H. Baldinger MD, Helge Servatius MD, Claudia Herrera Siklódy MD, Nikola Kozhuharov MD, Gregor Thalmann MD, PhD, Antonio Madaffari MD, Andreas Haeberlin MD, PhD, Fabian Noti MD, Hildegard Tanner MD, Tobias Reichlin MD, Laurent Roten MD

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引用次数: 0

Abstract

Background

Durable pulmonary vein isolation (PVI) is the primary objective of atrial fibrillation (AF) ablation, yet reconnections are common and non-PV mechanisms may drive recurrence in persistent AF.

Objectives

This study sought to compare PVI durability and arrhythmia recurrence between pulsed field ablation (PFA) and radiofrequency ablation (RFA) in persistent AF patients.

Methods

Persistent AF patients undergoing PVI were prospectively enrolled, with a mandatory remapping procedure performed after 6 months regardless of recurrence. RFA was used in phase 1 (n = 30) and PFA was used in phase 2 (n = 30). Patients were followed with 7-day Holter electrocardiograms after 3, 6, and 12 months. Primary and secondary endpoints were PVI durability and arrhythmia recurrence.

Results

Of 60 enrolled patients, 51 underwent the mandated remapping procedure after a median of 7.2 months (mean age 68 years; 82% male). PVI was durable in 78 of 102 PVs (76%) with RFA and in 82 of 104 PVs (79%) with PFA (adjusted OR: 1.20; 95% CI: 0.37-3.88; P = 0.77), with lowest durability in the right superior PV (PFA 72%; RFA 69%). All PVs were durably isolated in 26 patients (51%). Of 26 patients (51%) with durably isolated PVs, 9 (35%) experienced AF recurrence prior to the remapping procedure. Of 25 patients (49%) with reconnected PVs, 7 (28%) experienced AF recurrence. At 1-year follow-up, freedom from recurrence after mandated redo procedure was 70% with no difference between the 2 ablation technologies (adjusted HR: 0.80; 95% CI: 0.24-2.64; P = 0.71).

Conclusions

In patients with persistent AF, PFA demonstrated PVI durability comparable to RFA. Arrhythmia recurrence occurred in a substantial proportion of patients with durable PVI, suggesting a role for non-PV mechanisms.

查看原文本刊更多论文

持续性房颤PFA或RFA后的PVI耐久性：来自强制性前瞻性重新定位研究的见解。

背景：持久肺静脉隔离（PVI）是房颤（AF）消融的主要目的，然而再连接是常见的，非pv机制可能导致持续性房颤复发。目的：本研究旨在比较脉冲场消融（PFA）和射频消融（RFA）在持续性房颤患者中的PVI持久性和心律失常复发。方法：前瞻性地纳入接受PVI的持续性房颤患者，无论复发与否，6个月后进行强制性重新定位手术。第1期采用RFA (n = 30)，第2期采用PFA （n = 30）。患者在3、6、12个月后随访7天动态心电图。主要和次要终点是PVI持续时间和心律失常复发。结果：60例入组患者中，51例在中位7.2个月后（平均年龄68岁，82%为男性）接受了强制重新定位手术。102个PV中有78个（76%）使用RFA，而104个PV中有82个（79%）使用PFA（校正OR: 1.20; 95% CI: 0.37-3.88; P = 0.77）， PFA的耐久性最低（PFA 72%; RFA 69%）。26例（51%）患者的所有pv均被持久分离。在26例（51%）持久分离pv患者中，9例（35%）在重新定位手术前经历了房颤复发。在25例（49%）pv再连接患者中，7例（28%）发生房颤复发。在1年的随访中，强制重做手术后的复发率为70%，两种消融技术之间没有差异（调整后风险比：0.80;95% CI: 0.24-2.64; P = 0.71）。结论：在持续性房颤患者中，PFA表现出与RFA相当的PVI持久性。心律失常复发发生在相当大比例的持续性PVI患者中，提示非pv机制的作用。

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

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.