Roberto Scacciavillani MD , Domenico G. Della Rocca MD, PhD , Devi Nair MD , Michele Magnocavallo MD , Andrzej Głowniak MD , Sanghamitra Mohanty MD , Antonio Sorgente MD, PhD , Roberto Mené MD , Alexandre Almorad MD , Giampaolo Vetta MD , Luigi Pannone MD , Katarzyna Wojewoda MD , Lorenzo Marcon MD , Erwin Stroker MD, PhD , Gezim Bala MD, PhD , Aleksander Konopka MD , Juan Sieira MD, PhD , Stefano Bianchi MD, PhD , Kirollos Gabrah DO , Pietro Rossi MD, PhD , Gian-Battista Chierchia MD, PhD
{"title":"Safety and Feasibility of Pulsed-Field Ablation in Patients With Mechanical Prosthetic Valves","authors":"Roberto Scacciavillani MD , Domenico G. Della Rocca MD, PhD , Devi Nair MD , Michele Magnocavallo MD , Andrzej Głowniak MD , Sanghamitra Mohanty MD , Antonio Sorgente MD, PhD , Roberto Mené MD , Alexandre Almorad MD , Giampaolo Vetta MD , Luigi Pannone MD , Katarzyna Wojewoda MD , Lorenzo Marcon MD , Erwin Stroker MD, PhD , Gezim Bala MD, PhD , Aleksander Konopka MD , Juan Sieira MD, PhD , Stefano Bianchi MD, PhD , Kirollos Gabrah DO , Pietro Rossi MD, PhD , Gian-Battista Chierchia MD, PhD","doi":"10.1016/j.jacep.2024.09.025","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Pulsed-field ablation (PFA) is a novel ablation energy source, which leads to selective and irreversible electroporation of cardiomyocytes with no collateral damage to adjacent tissues. The presence of mechanical prosthetic valves may pose some issues related to catheter manipulation and risk of electromagnetic interference.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to assess the feasibility of PFA in patients with mechanical prosthetic valves.</div></div><div><h3>Methods</h3><div>The authors enrolled 30 consecutive patients (age 64.7 ± 11.4 years; 43% men) with mitral and/or aortic valve replacement with mechanical substitutes undergoing endocardial AF ablation via a PFA technology at 6 institutions.</div></div><div><h3>Results</h3><div>Time between valve surgery and ablation was 6.6 ± 6.5 years; 14 (46.7%) patients had an aortic mechanical valve, 10 (33.3%) a mitral, and 6 (20.0%) both. The following PFA technologies were used: FARAWAVE in 25 patients, Sphere-9 in 2, PulseSelect in 2, and the CENTAURI System in 1. No periprocedural and 1-month postablation major and minor complications were observed. Postprocedural transthoracic echocardiography did not identify any prosthetic valve dysfunction. One patient showed electromagnetic interference of the PFA catheter adjacent to the mitral prosthesis without clinical implications. No energy delivery to the mitral edge of the isthmus was possible despite multiple attempts to reposition the catheter. Mean procedural time was 77.5 ± 29.9 minutes, whereas mean left atrial dwell and fluoroscopy times were 43.1 ± 21.4 and 14.0 ± 6.4 minutes, respectively.</div></div><div><h3>Conclusions</h3><div>PFA in patients with mechanical valves appears safe, but careful catheter handling is essential to avoid electromagnetic interference hindering PFA delivery.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 1","pages":"Pages 98-106"},"PeriodicalIF":8.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Clinical electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405500X24008521","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Pulsed-field ablation (PFA) is a novel ablation energy source, which leads to selective and irreversible electroporation of cardiomyocytes with no collateral damage to adjacent tissues. The presence of mechanical prosthetic valves may pose some issues related to catheter manipulation and risk of electromagnetic interference.
Objectives
The purpose of this study was to assess the feasibility of PFA in patients with mechanical prosthetic valves.
Methods
The authors enrolled 30 consecutive patients (age 64.7 ± 11.4 years; 43% men) with mitral and/or aortic valve replacement with mechanical substitutes undergoing endocardial AF ablation via a PFA technology at 6 institutions.
Results
Time between valve surgery and ablation was 6.6 ± 6.5 years; 14 (46.7%) patients had an aortic mechanical valve, 10 (33.3%) a mitral, and 6 (20.0%) both. The following PFA technologies were used: FARAWAVE in 25 patients, Sphere-9 in 2, PulseSelect in 2, and the CENTAURI System in 1. No periprocedural and 1-month postablation major and minor complications were observed. Postprocedural transthoracic echocardiography did not identify any prosthetic valve dysfunction. One patient showed electromagnetic interference of the PFA catheter adjacent to the mitral prosthesis without clinical implications. No energy delivery to the mitral edge of the isthmus was possible despite multiple attempts to reposition the catheter. Mean procedural time was 77.5 ± 29.9 minutes, whereas mean left atrial dwell and fluoroscopy times were 43.1 ± 21.4 and 14.0 ± 6.4 minutes, respectively.
Conclusions
PFA in patients with mechanical valves appears safe, but careful catheter handling is essential to avoid electromagnetic interference hindering PFA delivery.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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