A Focal Ablation Catheter Toggling Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation

Reddy, Vivek Y.; Peichl, Petr; Anter, Elad; Račkauskas, Gediminas; Petrů, Jan; Funasako, Moritoshi; Minami, Kentaro; Koruth, Jacob S.; Jaı̈s, Pierre; Marinskis, Germanas; Aidietis, Audrius; Kautzner, Josef; Neužil, Petr

doi:10.1016/j.jacep.2023.04.002

Cited by 53 publications

(36 citation statements)

References 28 publications

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“…However, our results are in line with the large non‐randomized MANIFEST and EU‐PORIA registries including patients undergoing PFA PVI with the FARAPULSE™ system and reporting an arrhythmia‐free survival in PAF and persAF of 78% and 76% after 12 months 13,22 . Moreover, our data are comparable to results from a recently published study analyzing outcomes using a lattice‐tip catheter 24 . Of note, long‐term freedom from atrial arrhythmias in our study was favorable compared to findings from a trial enrolling 150 patients undergoing PFA PVI with a circular PFA catheter 11 .…”

Section: Discussionsupporting

confidence: 90%

“…13,22 Moreover, our data are comparable to results from a recently published study analyzing outcomes using a lattice-tip catheter. 24 Of note, long-term freedom from atrial arrhythmias in our study was favorable compared to findings from a trial enrolling 150 patients undergoing PFA PVI with a circular PFA catheter. 11 However, our findings using the FARAPULSE™ system are not transferable to other PFA systems.…”

Section: Discussionsupporting

confidence: 48%

“…However, our findings using the FARAPULSE™ system are not transferable to other PFA systems. Each system using PFA applies distinct waveforms and energy settings with potentially different outcomes and safety profiles 24 …”

Section: Discussionmentioning

confidence: 99%

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Comparison of pulsed field ablation and cryoballoon ablation for pulmonary vein isolation

Schipper,

Steven,

Lüker

et al. 2023

Cardiovasc electrophysiol

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IntroductionPulmonary vein isolation (PVI) remains the cornerstone in the treatment of atrial fibrillation (AF). PVI using cryoballoon (CB) technology has emerged as a standard procedure in many centers. Recently, pulsed field ablation (PFA) has been introduced and used to achieve PVI. First data show high acute and favorable long‐term outcomes. So far, data comparing these new “single shot” devices are sparse. We sought to compare procedural and outcome data for first time PFA users versus CB in patients undergoing de novo PVI. Furthermore, potentially postprocedural discomfort and affection of autonomic ganglia were assessed.Methods and ResultsA retrospective analysis and comparison of all de novo PVIs with PFA and CB was performed. Furthermore, PFA PVI learning curve was evaluated. During follow‐up, repeat outpatient visits and Holter electrocardiogram were performed to analyze arrhythmia‐free survival. Discomfort analysis was obtained by prescribed analgesic medication within first 48 h after PVI. Potential changes in heart rate (HR) between baseline and at 3‐month follow‐up were evaluated. A total of 108 patients (54 PFA and 54 CB; PFA; 33 (30%) female) with paroxysmal and persistent AF were analyzed. Type of AF was comparable (Patients suffering from PAF: PFA: 16 (30%), CB: 17 (31%), p = 1.0). In 107 (99%) patients, successful PVI was achieved. Transient phrenic palsy omitted complete PVI in one CB patient. A trend for a shorter overall procedure duration was observed in the PFA group (PFA: 64.5 ± 17.5 min; CB: 73.0 ± 24.8 min; p = 0.07). Excluding LA mapping time (first 14 cases), procedure time was significantly shorter using PFA (PFA: 58.0 ± 12.5 min, CB: 73.0 ± 24.8 min, p = 0.0001). Fluoroscopy time was significantly longer for PFA (PFA: 15.3 ± 4.7 min, CB: 12.3 ± 5.3 min; p = 0.001), but significantly less contrast medium was used (PFA: 12 ± 6 mL; CB: 51 ± 29 mL, p < 0.0001). Subgroup analysis of the PFA group revealed a significant shortening of procedure duration over time (first tertile: 72.7 ± 13.5 min, second tertile: 67.3 ± 21.7 min, third tertile: 53.4 ± 9.8 min, first vs. third tertile p < 0.0001). Two cardiac tamponades occurred in the PFA group (p = 0.495), of which one was most likely related to complex transseptal puncture. In the first 48 h after PVI, the number of prescribed analgesics due to postprocedural pain was equal between both groups (PFA: 7 (13%) patients, CB: 10 (19%) patients, p = 0.598). After a FU of 273 ± 129 days, 35 of 47 patients (74%) after PFA and 36 of 50 patients (72%) after CB PVI were free of any atrial arrhythmia (HR: 0.98, p = 0.88). Only in the PFA group, a significant increase in HR 3 months after PVI was observed (pre‐PVI: 61 ± 8 beats/min, post‐PVI: 65 ± 9 beats/min, p = 0.008).ConclusionThe new PFA technology is equally effective and safe as compared to CB for complete PVI with potentially shorter procedure time and significantly less contrast medium. However, AF recurrence rates after PFA PVI seem to be comparable to CB PVI.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 48%

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Comparison of pulsed field ablation and cryoballoon ablation for pulmonary vein isolation

Schipper,

Steven,

Lüker

et al. 2023

Cardiovasc electrophysiol

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“…Indeed, clinical reports demonstrated frequent pulmonary vein reconnections at relook procedures despite near universal acute isolation at the initial procedure. [8][9][10][11][12][13][14] See Article by Amorós-Figueras et al…”

Section: Editorialmentioning

confidence: 99%

Predicting Lesion Durability With PFA: One Step Closer

Koruth,

Kawamura

2023

Circ: Arrhythmia and Electrophysiology

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“…4). In this study, a cohort of 178 patients with persistent or paroxysmal atrial fibrillation underwent PFA and RF ablation [8 ▪ ]. The PFA waveforms were modified throughout the investigation (PULSE 1–2–3) and additional lines beyond the pulmonary vein isolation were added at the physician's discretion.…”

Section: The Pulse Field Ablation Systems and Multicenter Studiesmentioning

confidence: 99%

Perspectives on pulsed field ablation: how to judge endpoints

Anglesio,

Verma

2023

Current Opinion in Cardiology

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Purpose of review This review highlights pulse field ablation's (PFA) significance in treating atrial fibrillation. PFA uses short-pulsed electrical fields, offering safety advantages over thermal methods. Multicenter studies’ findings on PFA's safety, efficiency, and efficacy, compared with thermal techniques, are discussed. Recent findings The review encompasses major PFA systems utilized in multicenter studies: penta-spline, circular, and lattice catheters. These studies affirm PFA's safety, with minimal complications like esophageal injury, phrenic nerve complications, and pulmonary vein stenosis. PFA also demonstrates procedural efficiency benefits because of rapid pulse delivery. However, PFA's efficacy appears on par with thermal ablation, showing similar rates of atrial arrhythmia recurrence during follow-up periods. The studies explore diverse postablation monitoring strategies, underscoring the necessity for standardized monitoring or consistent transformation of arrhythmia data. Summary In conclusion, PFA marks a promising era for atrial fibrillation treatment with improved safety and efficiency. Efficacy is comparable to thermal methods, though technology advancements could alter this. PFA's potential as a safer and faster alternative positions it as a dominant atrial fibrillation ablation technology. Careful analysis and standardized monitoring are vital to assess PFA's potential and clinical implications

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A Focal Ablation Catheter Toggling Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation

Cited by 53 publications

References 28 publications

Comparison of pulsed field ablation and cryoballoon ablation for pulmonary vein isolation

Comparison of pulsed field ablation and cryoballoon ablation for pulmonary vein isolation

Predicting Lesion Durability With PFA: One Step Closer

Perspectives on pulsed field ablation: how to judge endpoints

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