Pulsed Field Ablation in Patients With Persistent Atrial Fibrillation

Reddy, Vivek Y.; Anić, Ante; Koruth, Jacob S.; Petrů, Jan; Funasako, Moritoshi; Minami, Kentaro; Brešković, Toni; Sikirić, Ivan; Dukkipati, Srinivas R.; Kawamura, Iwanari; Neužil, Petr

doi:10.1016/j.jacc.2020.07.007

Cited by 258 publications

(269 citation statements)

References 15 publications

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“…As a result, ablation can be performed in a very short time in the areas of interest of the myocardium, avoiding damage to neighboring organs such as the esophagus [ 75 ]. In a recently published study, Reddy et al using pulsed field ablation with a “one-shot” multispline catheter conducted successful PVI and LA posterior wall isolation in 25 patients with persistent AF [ 76 ]. It is obvious that current mapping systems are being prepared for changes in the coming years, as their upgrades will integrate new technologies that have proven to be effective and easy to use.…”

Section: The Theoretical Knowledge In Clinical Practicementioning

confidence: 99%

The Electrophysiology of Atrial Fibrillation: From Basic Mechanisms to Catheter Ablation

Ioannidis¹,

Zografos²,

Christoforatou³

et al. 2021

Cardiology Research and Practice

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The electrophysiology of atrial fibrillation (AF) has always been a deep mystery in understanding this complex arrhythmia. The pathophysiological mechanisms of AF are complex and often remain unclear despite extensive research. Therefore, the implementation of basic science knowledge to clinical practice is challenging. After more than 20 years, pulmonary vein isolation (PVI) remains the cornerstone ablation strategy for maintaining the sinus rhythm (SR). However, there is no doubt that, in many cases, especially in persistent and long-standing persistent AF, PVI is not enough, and eventually, the restoration of SR occurs after additional intervention in the rest of the atrial myocardium. Substrate mapping is a modern challenge as it can reveal focal sources or rotational activities that may be responsible for maintaining AF. Whether these areas are actually the cause of the AF maintenance is unknown. If this really happens, then the targeted ablation may be the solution; otherwise, more rough techniques such as atrial compartmentalization may prove to be more effective. In this article, we attempt a broad review of the known pathophysiological mechanisms of AF, and we present the recent efforts of advanced technology initially to reveal the electrical impulse during AF and then to intervene effectively with ablation.

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Section: The Theoretical Knowledge In Clinical Practicementioning

confidence: 99%

The Electrophysiology of Atrial Fibrillation: From Basic Mechanisms to Catheter Ablation

Ioannidis¹,

Zografos²,

Christoforatou³

et al. 2021

Cardiology Research and Practice

View full text Add to dashboard Cite

show abstract

“…11,12 More recently, results from the Feasibility Study of the FARAPULSE Endocardial Multiablation System in the Treatment of Persistent AF (PersAFOne) demonstrating the benefits of pulsed-field ablation employing both a pulmonary vein strategy and a posterior wall ablation strategy for the treatment of persistent AF were published. 13 Posterior wall ablation/isolation increases the success rates for ablation for persistent AF 14 but, certainly, a limitation to the widespread adoption of this approach remains the potential for esophageal injury with traditional energy sources. The study was a single-arm study using a multispline catheter and biphasic bipolar pulsed-field ablation (Farapulse Inc., Menlo Park, CA, USA).…”

Section: Electroporationmentioning

confidence: 99%

The State of Atrial Fibrillation in 2020

Doshi

2021

J Innov Cardiac Rhythm Manage.

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“…Of the alternative future methods of ablation, pulsed-field ablation appears to hold great promise, having demonstrated impressive durability in a small study of PeAF patients (n = 25), 73 with invasive remapping demonstrating 96% durability of PVI and 100% durability of posterior wall isolation, after showing impressive three-month durability of PVI in PAF (100%) also by invasive remapping. 74 PFA, in particular, appears to offer an exciting capability to achieve transmurability with avoidance of collateral damage to the phrenic nerves and esophagus due to its myocardial selectivity.…”

Section: Looking To the Futurementioning

confidence: 99%

Optimizing Durability in Radiofrequency Ablation of Atrial Fibrillation

Sharif

Heist

2021

J Innov Cardiac Rhythm Manage.

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Radiofrequency ablation (RFA) remains a highly effective therapy in the management of paroxysmal atrial fibrillation (PAF) and is an important therapeutic option in the management of persistent atrial fibrillation (PeAF) when clinically indicated. Lesion size is influenced by many parameters, which include those related to energy application (RFA power, temperature, and time), delivery mechanism (electrode size, orientation, and contact force), and the environment (blood flow and local tissue contact, stability, and local impedance). Successful durable RFA is dependent on achieving lesions that are reliably transmural and contiguous, whilst also avoiding injury to the surrounding structures. This review focuses on the variables that can be adjusted in connection with RFA to achieve long-lasting lesions that enable patients to derive the maximum sustained benefit from pulmonary vein isolation and additional lesion sets if utilized.

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Pulsed Field Ablation in Patients With Persistent Atrial Fibrillation

Cited by 258 publications

References 15 publications

The Electrophysiology of Atrial Fibrillation: From Basic Mechanisms to Catheter Ablation

The Electrophysiology of Atrial Fibrillation: From Basic Mechanisms to Catheter Ablation

The State of Atrial Fibrillation in 2020

Optimizing Durability in Radiofrequency Ablation of Atrial Fibrillation

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