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Atrial fibrilation cathether ablation: Electroporation against high-power short duration radiofrequency
Session:
Comunicações Orais - Sessão 03 - Fibrilhação auricular - Inovações no tratamento ablativo
Speaker:
Rita Reis Santos
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.4 Arrhythmias, General – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Reis Santos; Daniel Matos; Daniel Gomes; Mariana S. Paiva; Gabriela Bem; Gustavo Rodrigues; João Carmo; Francisco Costa; Pedro G. Santos; Pedro Carmo; Francisco Morgado; Diogo Cavaco; Miguel Mendes; Pedro Adragão
Abstract
<p style="margin-left:-38px; text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">B</span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">KGROUND: </span></span></span></strong><span style="font-size:13.5pt"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Pulmonary vein isolation (PVI) is one of the cornerstones of rhythm-control therapy for symptomatic atrial fibrillation (AF) patients. The new ablation technologies of pulse field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) with the new QDOT</span></span></span></span><span style="font-size:11.5pt"><span style="background-color:white"><span style="font-family:"Source Sans Pro",sans-serif"><span style="color:black">®</span></span></span></span><span style="font-size:13.5pt"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> catheter have been recently introduced in the EP lab.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">AIM: </span></span></span></strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">To evaluate and compare <span style="background-color:white">the efficacy, and safety of single-shot PFA and HPSDRA for PVI in AF symptomatic patients.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">METHODS: </span></span></span></strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Single centre, retrospective study of consecutive patients undergoing PVI with PFA or <span style="background-color:white">HPSD between </span>May-December 2022. Data on demographic, procedural and clinical/ electrocardiographic recurrence (assessed after a 3-months blanking period) were analysed. Comparative analysis between both techniques was performed.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">RESULTS:</span></span></span></strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> One hundred and ten consecutive patients were included (63 </span></span></span><span style="font-size:13.5pt"><span style="font-family:Symbol"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> 11 years, 75% men), with a mean CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 2</span></span></span><span style="font-size:13.5pt"><span style="font-family:Symbol"><span style="color:black">±</span></span></span><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">1 points, median LVEF of 61% [IQR 57-62%] and a median left atrial volume index (by CT scan) of 56 mL/m<sup>2</sup> [IQR 51-67 mL/m<sup>2</sup>]. 55% patients presented paroxysmal-AF and 19 patients (17%) performed a redo ablation. 47% (n=52) patients performed <span style="background-color:white">HPSD</span> and 53% (n=58) PFA (all with CARTO</span></span></span><span style="font-size:11.5pt"><span style="background-color:white"><span style="font-family:"Source Sans Pro",sans-serif"><span style="color:black">®</span></span></span></span><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">3D system v.7 and high-density mapping). In the <span style="background-color:white">HPSD</span>: median RF ablation time was 792 sec [IQR 614-919sec], while in PFA was 90 sec [IQR 30-138 sec]. Median time of catheter inside the LA for PFA was 18 min [IQR 2-33 min]. Comparing <span style="background-color:white">HPSD</span> and PFA (Fig 1): median procedure time was similar (91 min [IQR 71-107 min] <em><span style="font-family:"Calibri",sans-serif">vs</span></em> 89 min [IQR 66-111 min], <em><span style="font-family:"Calibri",sans-serif">p</span></em>=0.261), while median fluoroscopy time was lower with <span style="background-color:white">HPSD</span> (5.4 min [IQR 3.1-6.8 min] <em><span style="font-family:"Calibri",sans-serif">vs</span></em> 13.2 min [IQR 10.3-15.6 min], <em><span style="font-family:"Calibri",sans-serif">p</span></em><0.001); posterior wall isolation (PWI) was performed in 5 (10%) <span style="background-color:white">HPSD</span> <em><span style="font-family:"Calibri",sans-serif">vs</span></em> 21 (37%) PFA patients (p<0.001). All PFA patients undergoing PWI had first pass isolation, while only 40% of <span style="background-color:white">HPSD</span> had first pass isolation. When performed PVI only, PFA presents a lower median procedure time than <span style="background-color:white">HPSD</span> (76 min [IQR 62-93 min] <em><span style="font-family:"Calibri",sans-serif">vs</span></em> 97 min [IQR 69-135 min], <em><span style="font-family:"Calibri",sans-serif">p</span></em>=0.048). There was only one major complication, a cardiac tamponade with PFA, treated with pericardiocentesis. At 3 months of follow-up, 17% (n=10) patients had clinical or electrocardiographic AF recurrence: 7 PFA patients and 3 <span style="background-color:white">HPSD</span> patients <span style="background-color:white">(</span><em><span style="font-family:"Calibri",sans-serif">p</span></em>=0.127).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">CONCLUSIONS:</span></span></span></strong><span style="font-size:13.5pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> PFA and <span style="background-color:white">HPSD were both feasible and safe. When undergoing PVI-only, procedure time was lower with PFA</span>. In patients undergoing PWI, PFA achieved higher first pass isolation. <span style="background-color:white">Although still in its early real-world evaluation, both techniques seem to be efficient, providing </span>low AF recurrence during follow-up.</span></span></span></span></span></p> <p> </p>
Slides
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