Pulsed field ablation using a focal contact force catheter allowed successful ablation of a focal right atrial tachycardia in the proximity of the phrenic nerve

Phlips, Thomas; Verhaeghe, L; Antole, Nathalie; Koopman, Pieter; Vijgen, Johan

doi:10.1016/j.hrcr.2023.03.016

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…As mentioned, we also successfully ablated one focal atrial tachycardia from the terminal crest in the right atrium as part of PVI ( +). Recently, a case report highlighted the possibilities of successful FPFA of an AT in close proximity to the phrenic nerve [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Focal pulsed field ablation and ultrahigh-density mapping — versatile tools for all atrial arrhythmias? Initial procedural experiences

Ruwald

Johannessen

Hansen

et al. 2023

J Interv Card Electrophysiol

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Background Focal pulsed field ablation (FPFA) is a novel and promising method of cardiac ablation. The aim of this study was to report the feasibility, short-term safety, and procedural findings for a broad spectrum of ablated atrial arrhythmias. Methods Patients (n = 51) scheduled for ablation of atrial arrhythmias were prospectively included and underwent FPFA using the Galvanize CENTAURI generator with energy delivery through commercially available ablation catheters with ultrahigh-density (UHDx) 3D electroanatomic voltage/local activation time map evaluations. Workflow, procedural data, and peri-procedural technical errors and complications are described. Results Planned ablation strategy was achieved with FPFA-only in 48/51 (94%) of the cases. Ablation strategy was first-time pulmonary vein isolation (PVI) in 17/51 (36%), repeat ablation in 18/51 (38%), PVI + in 13/51 (28%), and cavotricuspid isthmus block (CTI)-only in 3/51 (6%). The mean procedure time was 104 ± 31 min (first-time PVI), 114 ± 26 min (repeat procedure), 152 ± 36 min (PVI +), and 62 ± 17 min (CTI). Mean UHDx mapping time to assess lesion formation and block after ablation was 7 ± 4 min with 5485 ± 4809 points. First pass acute (linear) isolation with bidirectional block for anatomical lesion sets was 120/124 (97%) for all PVs, 17/17 (100%) for (any) isthmus, and 14/17 (82%) for left atrium posterior wall (LAPW). We observed several time-consuming integration errors with the used ablation system (mean 3.4 ± 3.7 errors/procedure), one transient inferior ST elevation when ablating CTI resolved by intravenous nitroglycerine and one transient AV block requiring temporary pacing for > 24 h. Conclusions FPFA was a highly versatile method to treat atrial arrhythmias with high first-pass efficiency. UHDx revealed acute homogenous low-voltage lesions in ablated areas. More data is needed to establish lesion durability and limitations of FPFA.

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Section: Discussionmentioning

confidence: 99%

Focal pulsed field ablation and ultrahigh-density mapping — versatile tools for all atrial arrhythmias? Initial procedural experiences

Ruwald

Johannessen

Hansen

et al. 2023

J Interv Card Electrophysiol

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“…All these data are derived from patients undergoing PVI with single-shot PFA devices. Despite 1 case report describing successful and safe endocardial PFA energy delivery directly at the site of maximal phrenic nerve capture, 14 safety data remain poor in this situation. In our patient, phrenic stimulation at the end of the procedure still demonstrated phrenic capture (manual diaphragmatic palpation and diaphragmatic excursion on fluoroscopy) without any signs of phrenic nerve injury during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Focal point-by-point pulsed field ablation for the treatment of atrial arrhythmias in patients with challenging anatomy where radiofrequency ablation cannot be applied: A case series

Farnir,

Luermans,

Manusama

et al. 2024

HeartRhythm Case Reports

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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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Pulsed field ablation using a focal contact force catheter allowed successful ablation of a focal right atrial tachycardia in the proximity of the phrenic nerve

Cited by 8 publications

References 12 publications

Focal pulsed field ablation and ultrahigh-density mapping — versatile tools for all atrial arrhythmias? Initial procedural experiences

Focal pulsed field ablation and ultrahigh-density mapping — versatile tools for all atrial arrhythmias? Initial procedural experiences

Focal point-by-point pulsed field ablation for the treatment of atrial arrhythmias in patients with challenging anatomy where radiofrequency ablation cannot be applied: A case series

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

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