Influence of monitoring and atrial arrhythmia burden on quality of life and health care utilization in patients undergoing pulsed field ablation: A secondary analysis of the PULSED AF trial

Haines, David E.; Boersma, Lucas V.A.; Sood, Nitesh; Marchlinski, Francis E.; Calkins, Hugh; Sanders, Prashanthan; Packer, Douglas L.; Kuck, Karl‐Heinz; Hindricks, Gerhard; Tada, Hiroshi; Hoyt, Robert; Irwin, James M.; Andrade, Jason G.; Cerkvenik, Jeffrey; Selma, Jada; Delurgio, David B.

doi:10.1016/j.hrthm.2023.05.018

Cited by 14 publications

(3 citation statements)

References 19 publications

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“…6,16,22 However, the operator can never be certain that this empirical approach will work for varying tissue thickness, scarring, and anatomic shape. Despite optimized pulse voltage and waveforms showing transmurality in animal models, success rates of PFA remain similar to thermal modalities 6,23 with enduring pulmonary vein reconnections. 24 To date, there are really no other real-time assessments that an operator can use to ensure the durability of any given PFA lesion.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Pulsed Field Ablation Lesion Durability Assessed by Polarization-Sensitive Optical Coherence Reflectometry

Terricabras,

Martins,

Peinado

et al. 2024

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: Pulsed field ablation uses electrical fields to cause nonthermal cell death over several hours. Polarization-sensitive optical coherence reflectometry is an optical imaging technique that can detect changes in the tissue ultrastructure in real time, which occurs when muscular tissue is damaged. The objective of this study was to evaluate the ability of a polarization-sensitive optical coherence reflectometry system to predict the development of chronic lesions based on acute changes in tissue birefringence during pulsed field ablation. METHODS: Superior vena cava isolation was performed in 30 swine using a biphasic, bipolar pulsed field ablation system delivered with a nonirrigated focal tip catheter. Acute changes in tissue birefringence and voltage abatement were analyzed for each individual lesion. A high-resolution electroanatomical map was performed at baseline and 4 to 12 weeks after ablation to locate electrical gaps in the ablated area. RESULTS: A total of 141 lesions were delivered and included in the analysis. Acute electrical isolation based on the electroanatomical map was achieved in 96% of the animals, but chronic isolation was only seen in 14 animals (46%). The mean voltage abatement of lesions that showed recovery was 82.8%±14.6% versus 84.4%±17.4% for those that showed fibrosis ( P =0.7). The mean acute reduction in tissue birefringence in points demonstrating fibrosis was 63.8%±11.3% versus 9.1%±0.1% in the points that resulted in electrical gaps. A threshold of acute reduction of birefringence of ≥20% could predict chronic lesion formation with a sensitivity of 96% and a specificity of 83%. CONCLUSIONS: Acute tissue birefringence changes assessed with polarization-sensitive optical coherence reflectometry during pulsed field ablation can predict chronic lesion formation and guide the ablation procedure although limited by the tissue thickness.

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Section: Discussionmentioning

confidence: 99%

Cardiac Pulsed Field Ablation Lesion Durability Assessed by Polarization-Sensitive Optical Coherence Reflectometry

Terricabras,

Martins,

Peinado

et al. 2024

Circ: Arrhythmia and Electrophysiology

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“…Holter recordings and TTM transmissions were used. 69.4% of paroxysmal and 62.2% of persistent patients showed no atrial arrhythmia (A.A.) burden; 87.1% of paroxysmal and 81.8% of persistent patients showed A.A. burden <10% ( 15 ).…”

Section: Other Studiesmentioning

confidence: 99%

The promise of pulsed field ablation and the challenges ahead

Iyengar,

Srivathsan

2023

Front. Cardiovasc. Med.

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For many years, guidelines have suggested thermal ablation for the treatment of atrial fibrillation. Thermal ablation involves the destruction of tissue, leading to multiple complications. This ablation technique has been tried and tested, however, newer techniques are being investigated in order to avoid these complications. Pulsed field ablation, a nonthermal method of tissue ablation, is being explored as a more safe and efficient way to treat atrial fibrillation. This mini review aims to highlight the mechanisms of pulsed field ablation, its history and evolution, previous studies showing its efficacy, its major challenges and pitfalls, and future advancements to overcome these challenges. This method of ablation could potentially revolutionize the treatment of atrial fibrillation and prevent recurrences, thereby making it easier for the physicians and patients involved.

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“…In a sub-analysis of the PULSED-AF trial, Verma et al . 9 demonstrated how 1 year freedom of arrhythmia would be more than 90% if only 48 h Holter recordings would have been performed, while it was actually 70% by adding weekly trans-telephonic monitoring during the first year. This demonstrates that we should be careful to interpret freedom of arrhythmia being reported in AF ablation studies if there is no standardized intermittent, or continuous monitoring, or comparative control group.…”

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confidence: 99%