Florent Farnir, Sevasti-Maria Chaldoupi, Ben J M Hermans, Frédéric Farnir, Zarina Habibi, Kezia Jerltorp, Dominique Verhaert, Ulrich Schotten, Bart Maesen, Kevin Vernooy, Justin Luermans, Dominik Linz
{"title":"针对心房颤动和晚期心房底物患者，采用针对性脉冲场导管消融治疗底物的方法：程序数据和6个月的成功率","authors":"Florent Farnir, Sevasti-Maria Chaldoupi, Ben J M Hermans, Frédéric Farnir, Zarina Habibi, Kezia Jerltorp, Dominique Verhaert, Ulrich Schotten, Bart Maesen, Kevin Vernooy, Justin Luermans, Dominik Linz","doi":"10.1016/j.hrthm.2025.01.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF).</p><p><strong>Objective: </strong>We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate.</p><p><strong>Methods: </strong>Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force-sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated.</p><p><strong>Results: </strong>In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m<sup>2</sup>; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl).</p><p><strong>Conclusion: </strong>Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates.\",\"authors\":\"Florent Farnir, Sevasti-Maria Chaldoupi, Ben J M Hermans, Frédéric Farnir, Zarina Habibi, Kezia Jerltorp, Dominique Verhaert, Ulrich Schotten, Bart Maesen, Kevin Vernooy, Justin Luermans, Dominik Linz\",\"doi\":\"10.1016/j.hrthm.2025.01.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF).</p><p><strong>Objective: </strong>We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate.</p><p><strong>Methods: </strong>Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force-sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated.</p><p><strong>Results: </strong>In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m<sup>2</sup>; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl).</p><p><strong>Conclusion: </strong>Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.</p>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2025-01-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hrthm.2025.01.015\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2025.01.015","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates.
Background: Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF).
Objective: We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate.
Methods: Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force-sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated.
Results: In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m2; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl).
Conclusion: Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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