Redo ablation procedures to treat recurrent atrial arrhythmias via a pentaspline pulsed field ablation catheter: a prospective, multicenter experience.
María Cespón-Fernández, Domenico G Della Rocca, Michele Magnocavallo, Andrés Betancur, Ilenia Lombardo, Luigi Pannone, Giampaolo Vetta, Antonio Sorgente, Marco Polselli, Charles Audiat, Alvise Del Monte, Stéphane Combes, Lorenzo Marcon, Ingrid Overeinder, Kazutaka Nakasone, Sahar Mouram, Sanghamitra Mohanty, Stefano Bianchi, Alexandre Almorad, Juan Sieira, Gezim Bala, Erwin Ströker, Pietro Rossi, Andrea Sarkozy, Serge Boveda, Andrea Natale, Carlo de Asmundis, Gian-Battista Chierchia
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引用次数: 0
Abstract
Background: Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.
Methods: Patients undergoing redo procedures with a pentaspline PFA system at three international centers were enrolled. A workflow was established based on rhythm at presentation: sinus rhythm (Group 1), atrial flutter/atrial tachycardia (Group 2), or AF (Group 3). Propensity score matching was used for comparison between PFA- and RF-based redo ablations.
Results: A total of 117 patients were included (Group 1: 64, Group 2: 18, Group 3: 35). PV re-isolation was required in 71.9% and 72.2% of Group 1 and 2 patients, respectively. PFA terminated all cases of non-cavotricuspid isthmus dependent flutter and 45.7% of cases of AF. One major complication (0.9%; frontal cerebral hematoma) was documented. Freedom from atrial tachyarrhythmias at 12 months was 78.3% (95% CI 69.6-84.8%) without statistically significant differences among groups (Group 1: 85.7%; Group 2: 77%; Group 3: 65.5%; p = 0.053). PFA led to similar arrhythmia freedom compared to RF, but with significantly shorter procedural and dwelling times.
Conclusion: The adoption of a pentaspline PFA system for repeat ablation procedures was feasible, safe, and effective at 1-year follow-up. No clinical differences were observed between PFA and RF; however, redo PFA cases were significantly shorter.
期刊介绍：
The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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