Incidence, types and predictors of AF recurrence after AF ablation with pulsed field ablation. A single-centre experience

Abstract

Funding Acknowledgements Type of funding sources: None. Background Pulsed field ablation (PFA) is an emerging method for atrial fibrillation (AF) ablation. However, there is little data about incidence, types, and predictors of AF recurrences after PFA for AF ablation. Methods We report our single-centre experience with PFA for AF ablation. Each procedure was performed under unconscious sedation with propofol and fentanyl. If needed, midazolam was added in rare cases. Fifteen minutes before transeptal puncture 70IU/kg of unfractionated heparin were administered, for an ACT level >300sec during the entire procedure. Isolation of pulmonary veins was started after administration of 1mg of atropine with 8 applications per vein (4 in basket, 4 in flower configuration). Afterwards all veins were checked for entrance- and exitblock to confirm isolation during SR. If needed, additional ablation was performed. Results In total, 124 patients undergoing AF ablation therapy with PFA between June 2021 to October 2022 were analysed. Mean age was 61±9 years, 39% were female. Mean CHADS-VASc Score was 2±1. Sixty-two percent had paroxysmal atrial fibrillation (PAF), 34% persistent AF, in 4% patients suffered from long standing persistent AF. In 85% (n=106) of procedures first pass isolation of all veins was possible. Primary success to achieve PV isolation was accomplished in all patients at the end of procedure. In addition to PVI, in 6,5% of patients cavotricuspid isthmus (CTI) was blocked, in another 7,3% the posterior wall was isolated during the first procedure. Mean procedure duration was 76±30 minutes, mean x-ray time 11±22 minutes. During 124 procedures, only one periprocedural complication was documented (vascular complication). Eighteen patients (14,5%) had recurrence of dysrhythmia after a blanking period of 3 months after a mean follow-up period of 167±150 days. Mean time to recurrence was 108±101 days. Patients with recurrences after the blanking period suffered significantly more often from diabetes (OR 0,21 (0,089-0,495); p>0.01) and hyperlipidaemia (OR: 0,198 (0,070-0,498); p>0.01). Until now we performed five re-do procedures of patients with recurrence of dysrhythmia after a PFA first-do procedure. The recurrent arrhythmia was AF (n=2), atypical AT (roof-dependent n=1, one mitral isthmus dependent n=1), and CTI-dependent flutter (n=1). All five patients had PV reconnections, and all could be successfully reablated. Conclusion AF ablation with PFA is associated with high SR success rate, and acceptable procedure duration and complication rates. Randomized studies are needed to further evaluate this new method compared with other ablation techniques.