María Cespón-Fernández, Domenico G Della Rocca, Michele Magnocavallo, Andrés Betancur, Ilenia Lombardo, Luigi Pannone, Giampaolo Vetta, Antonio Sorgente, Marco Polselli, Charles Audiat, Alvise Del Monte, Stéphane Combes, Lorenzo Marcon, Ingrid Overeinder, Kazutaka Nakasone, Sahar Mouram, Sanghamitra Mohanty, Stefano Bianchi, Alexandre Almorad, Juan Sieira, Gezim Bala, Erwin Ströker, Pietro Rossi, Andrea Sarkozy, Serge Boveda, Andrea Natale, Carlo de Asmundis, Gian-Battista Chierchia
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This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.</p><p><strong>Methods: </strong>Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations.</p><p><strong>Results: </strong>A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12 months was 78.3% (95% CI 69.6-84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; p = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times.</p><p><strong>Conclusion: </strong>The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. 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引用次数: 0
摘要
背景：接受房颤（AF）导管消融的患者可能需要重做手术，包括肺静脉（PV）重新隔离和/或消融PV外部位。脉冲场消融（PFA）为心脏组织提供了高度选择性的能量来源，有可能减少对邻近结构的附带损伤。本研究旨在评估使用pentaspline PFA系统进行再消融的可行性和有效性。方法：在三个国际中心使用pentaspline PFA系统进行重做手术的患者入组。根据就诊时的心律建立工作流程：窦性心律（第1组）、心房扑动/房性心动过速（第2组）或房颤（第3组）。倾向评分匹配用于比较基于PFA和基于rf的重做消融。结果：共纳入117例患者（组1:64例，组2:18例，组3:35例）。第1组和第2组分别有71.9%和72.2%的患者需要重新分离PV。PFA终止了所有非颈三尖瓣峡部依赖性扑动和45.7%的房颤病例。额脑血肿)。12个月无房性心动过速者为78.3% (95% CI 69.6-84.8%)，组间差异无统计学意义(第一组：85.7%；第二组：77%；第3组：65.5%；p = 0.053)。与RF相比，PFA导致类似的心律失常自由，但程序和停留时间明显缩短。结论：在1年随访中，采用pentaspline PFA系统进行重复消融手术是可行、安全、有效的。PFA与RF无临床差异；然而，重做PFA病例的时间明显缩短。
Redo ablation procedures to treat recurrent atrial arrhythmias via a pentaspline pulsed field ablation catheter: a prospective, multicenter experience.
Background: Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.
Methods: Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations.
Results: A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12 months was 78.3% (95% CI 69.6-84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; p = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times.
Conclusion: The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. No clinical differences were observed between PFA and RF; however, redo PFA cases were significantly shorter.
期刊介绍：
The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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