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Efficacy, efficiency and safety of pulsed field ablation in patients with atrial fibrillation
Session:
SESSÃO DE POSTERS 41 - ABLAÇÃO DE FIBRILHAÇÃO AURICULAR
Speaker:
Inês Rodrigues
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Arrobas Rodrigues; António Gonçalves; Marta Leite; Inês Neves; Rafael Teixeira; Mafalda Carrington; Marco Oliveira; Helena Gonçalves; João Primo; João Almeida; Paulo Fonseca; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pulsed field ablation (PFA) is a new ablation modality that uses electrical pulses to induce cell death via irreversible electroporation. Cardiac cells are more susceptible to the generated electrical fields compared to surrounding tissues. Therefore, PFA can be effective, while minimizing collateral damage. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To evaluate the clinical outcomes, procedural efficiency and safety of atrial fibrillation (AF) ablation using PFA at our centre. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients submitted to pulmonary vein isolation (PVI) using PFA between Jan and Sep 2024 were included. Two composite endpoints were defined: 1) new antiarrhythmic intervention (antiarrhythmic drug (AAD) reintroduction, electric cardioversion (ECV) or redo procedure), and 2) healthcare contacts (emergency department visits or hospitalization due to AF or congestive heart failure, ECV or redo procedure). AF recurrence during follow-up (FU) was assessed using a survival analysis, and the proportion of patients meeting the composite endpoints was determined. Quality of life (QoL) improvement was evaluated using the AFEQT score. Procedural efficiency and safety were analysed.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">53 patients were included (71,7% male; median age 63, IQR 18,8). Most had persistent AF (78,4%), enlarged left atria (median iVolLA 44ml/m2, IQR 15,3), and prior antiarrhythmic interventions (83,3% had previously used AAD, 58% had ≥1 prior ECV and 44% had a previous PVI procedure). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All pulmonary veins were successfully isolated in all procedures. Additional lesions were performed in 51% of patients, mostly at the posterior wall. The median procedural time was 80min (IQR 30). Only one procedural complication was documented (femoral pseudoaneurysm). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The median FU time was 209 days (IQR 84). In the survival analysis, 92% and 72% of the patients were free from AF recurrence at 6 and 12 months, respectively (<strong>Graph 1</strong>). During FU, the composite endpoint of new antiarrhythmic intervention occurred in 7,5% of patients and healthcare contacts were documented in 9,4%. Compared to baseline (median AFEQT 56,8, IQR 38,9), QoL significantly improved at 12 months, with an adjusted mean difference in the AFEQT score of +13,1 points (95% CI 2,1-42,1, p=0,02).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">PFA was performed in patients with high AF burden. Despite this, it proved to be a safe and effective procedure, demonstrating low rates of AF recurrence, clinically significant improvements in QoL, and a reduced need for new antiarrhythmic interventions or healthcare utilization. </span></span></p>
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