Pulsed-field ablation of recurrent right atrial tachycardia: expanding the use of electroporation beyond atrial fibrillation

Adeliño, Raquel; Combes, Stéphane; Bouazzaoui, Rim El; Albenque, Jean‐Paul; Combes, Nicolas; Boveda, Serge

doi:10.1093/europace/euac198

Cited by 7 publications

(3 citation statements)

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“…However, case reports about effective and safe PFA in right-sided AT with the pentaspline catheter as well as with a focal PFA catheter have been reported. 28 , 29 Yet, when it comes to cavotricuspid isthmus ablation with PFA, occurrence of coronary spasms in up to 100% of cases have been shown. 30 , 31 Therefore, PFA technology needs further development to be safely applicable to all structures in the atria.…”

Section: Discussionmentioning

confidence: 99%

Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping

Gunawardene,

Harloff,

Jularic

et al. 2024

Europace

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Background Catheter-ablation (CA) of post-ablation left-atrial tachycardias (LAT) can be challenging. So far, pulsed-field ablation (PFA) has not been compared to standard point-by-point radiofrequency-current (RFC) energy for LAT ablation. Aims To compare efficacy of PFA versus RFC in patients undergoing CA for LAT. Methods Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA-catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right-atrial-tachycardia (RAT) were ablated with RFC. Acute and chronic success were assessed. Results Fifty-six patients (n=28 each group, age 70 ± 9 years,75% male) were enrolled. A total of 77 AT (n=67 LAT, n=10 RAT; 77% macroreentries) occurred with n=32 LAT in the PFA- and n=35 LAT in the RFC-group. Of all LAT, 94% (PFA-group) vs. 91% (RFC-group) successfully terminated to sinus rhythm or another AT during ablation (p=1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 mins, p<0.0001) and fluoroscopy times longer in the PFA-group (PFA: 15 ± 9 vs. RFC: 11 ± 6mins, p=0.04). There were no major complications. After one-year follow-up, estimated arrhythmia-free survival was 63% (PFA-group) and 87% (RFC-group), (Hazard-Ratio 2.91 (95-%-CI: 1.11-7.65), p=0.0473). Conclusion PFA of post-ablation LAT using a pentaspline catheter is feasible, safe and faster but less effective compared to standard RFC ablation after one-year of follow-up. Future catheter-designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.

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Section: Discussionmentioning

confidence: 99%

Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping

Gunawardene,

Harloff,

Jularic

et al. 2024

Europace

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“…Due to their well-established risk profiles and broad market penetration, thermal cardiac ablation techniques are the tools of choice for invasive cardiologists and cardiac surgeons aiming to modify atrial arrhythmogenic substrate. PFA has slowly gained enthusiasm, though not approved by the Food and Drug Administration at this time, and is being evaluated for its efficacy in decreasing arrhythmogenic burden in supraventricular tachycardia [34] , atrial tachycardia [35,36] , atrial flutter [37] , and atrial fibrillation [38] . In the nonpharmacologic management of atrial fibrillation, the plasticity of atrial substrate may necessitate multiple ablation procedures, including repeat pulmonary vein isolations or lesion extension to deal with postablation macroreentrant atrial tachycardia.…”

Section: Efficacy and Pulmonary Vein Stenosismentioning

confidence: 99%

Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation

Chinyere,

Mori,

Hutchinson

2024

Vessel Plus

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The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA’s effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.

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“…Other successful PFA applications in right atrial tachycardias have been described in case reports. 98) 99) …”

Section: First Clinical Experiences Beyond Pulmonary Vein Isolationmentioning

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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Pulsed-field ablation of recurrent right atrial tachycardia: expanding the use of electroporation beyond atrial fibrillation

Cited by 7 publications

References 0 publications

Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping

Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping

Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation

Pearls and Pitfalls of Pulsed Field Ablation

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