Cerebral safety after pulsed field ablation for paroxysmal atrial fibrillation

Reinsch, Nico; Füting, Anna; Höwel, Dennis; Bell, J; Lin, Y; Neven, Kars

doi:10.1016/j.hrthm.2022.06.018

Cited by 28 publications

(12 citation statements)

References 32 publications

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“…Although not specifically evaluating occurrence of TIA or stroke no clinical appearance of the latter was observed. In the setting of PFA a recent trial showed a low incidence of 3% for silent brain ischemia 31 . Comparing data of both modalities is not yet available.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Wörmann,

Schipper,

Lüker

et al. 2023

Cardiovasc electrophysiol

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BackgroundThe newly introduced nonthermal pulsed field ablation (PFA) is a promising technology to achieve fast pulmonary vein isolation (PVI) with high acute success rates and good safety features. However, previous studies have shown that very high power short duration ablation (VHPSD) is also highly effective and fast to achieve PVI with potentially less arrhythmia recurrence compared to conventional radiofrequency ablation. Data comparing PFA to VHPSD‐PVI is lacking.ObjectiveThis study compared procedural and outcome data for PFA‐PVI to VHPSD‐PVI in patients with paroxysmal or persistent atrial fibrillation (PAF/persAF).MethodsConsecutive patients undergoing de novo PVI (PFA or VHPSD) were included in this analysis. For PFA‐PVI a pentaspline 20 electrode catheter was used. For VHPSD‐PVI an enhanced irrigated catheter with a power setting of 70 W/7 s (70 W/5 s at posterior wall) was employed in conjunction with electro‐anatomical mapping. All procedures were performed in deep analgo‐sedation.ResultsA total of n = 114 patients (n = 57[50%] PFA, n = 17[30%] PAF; n = 40[70%] persAF) were included in this analysis. PVI was successful in all patients. The PFA group revealed a significantly shorter procedure duration (65 ± 17 min vs. 95 ± 23 min, p < 0.01) but longer fluoroscopy time (PFA 15 ± 5 min and VHPSD 12 ± 3 min; p < 0.001). At follow‐up after median 125 days (interquartile range: 109–162) n = 46 PFA (80.7%) and n = 44 VHPSD pts (77.2%) were free from atrial arrhythmia after a single procedure (p = 0.819).Two tamponades occurred in the PFA while in VHPSD two pts suffered groin bleedings. One clinically nonsignificant PV stenosis occurred in the VHPSD group.ConclusionPulsed‐field ablation and VHPSD‐PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia‐free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit. Compared to PFA VHPSD‐PVI might ensure information on left atrial substrate allowing to target concomitant secondary tachycardias.

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Section: Discussionmentioning

confidence: 99%

“…In the setting of PFA a recent trial showed a low incidence of 3% for silent brain ischemia. 31 Comparing data of both modalities is not yet available.…”

Section: Main Findingsmentioning

confidence: 99%

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Wörmann,

Schipper,

Lüker

et al. 2023

Cardiovasc electrophysiol

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“…The lesion of unknown origin completely resolved during follow-up. 96) Chen et al 97) recently reported in a pilot cohort study that PFA in patients with implantable electronic devices (n=20) appears to be feasible and safe under the guidance of a systematic approach. The lack of esophageal affections, PV stenosis, rare events of transient phrenic nerve palsies or others reported after PFA is in line with preclinical studies and highlights the overall favorable safety profile of the technology.…”

Section: Pulsed Field Ablation: Efficacy Safety and Fields Of Applica...mentioning

confidence: 99%

Pearls and Pitfalls of Pulsed Field Ablation

et al. 2023

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Author's summary Pulsed field ablation (PFA) is a fast advancing technology in the interventional treatment of cardiac arrhythmias that utilizes the phenomenon of irreversible electroporation as a non-thermal energy source. Pre-clinical and first clinical studies suggest that PFA could overcome the main limitations of current standard of care energy sources and improve the efficacy and safety profile of cardiac catheter ablation. This review provides an overview of the current knowledge on PFA and discusses “pearls” and potential “pitfalls” of the technology.

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Section: Introductionmentioning

confidence: 97%

“…As a relatively new ablation technique, few have investigated the incidence of SCE with this device. Recently, the incidence of SCE after PFA was reported for the first time by Reinsch et al55 In this study, the authors enrolled 30 patients with symptomatic PAF who were treated with PFA. Ablation was performed without interruption of anticoagulation (one dose of dabigatran or apixaban was on hold on the morning of the procedure).…”

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confidence: 99%

Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review

Zhang

Sang

et al. 2023

Pacing Clinical Electrophis

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The incidence of silent cerebral emboli (SCE) associated with atrial fibrillation catheter ablation (AFCA) is much higher than that of stroke/transient ischemic attack (TIA). Interventional electrophysiologists have been increasingly alerted to asymptomatic cerebral infarction over the years. Plentiful studies revealed that diagnostic definitions, detection modalities, energy sources, ablation strategies, perioperative anticoagulation regimens, and patient‐related factors were associated with the risk of AFCA‐associated SCE. Studies related to non‐interventional procedures found that SCE may prompt stroke, cognitive decline, and dementia later in life, suggesting a possible role of AFCA‐associated SCE in the cognitive function of patients with AF. However, there is no consistent evidence for this view to date. Given that the majority of patients with AF being elderly and the increased risk of cognitive impairment in AF itself, efforts should be made to minimize the occurrence of AFCA‐associated SCE.

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Cerebral safety after pulsed field ablation for paroxysmal atrial fibrillation

Cited by 28 publications

References 32 publications

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Pearls and Pitfalls of Pulsed Field Ablation

Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review

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