SPC365

SAFETY AND EFFECTIVENESS OF PULSED FIELD ABLATION FOR PULMONARY VEIN ISOLATION IN ATRIAL FIBRILLATION PATIENTS: A SINGLE CENTRE EXPERIENCE

Session: Comunicações Orais - Sessão 11 - Ablação de fibrilhação auricular
Speaker: Rita Reis Santos

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Reis Santos; Ana Rita Bello; Pedro G. Santos; Daniel Matos; Gustavo Rodrigues; Mafalda Sousa; Francisco Costa; Pedro Carmo; Francisco Morgado; Diogo Cavaco; Andrea Haas; Pedro Adragão

<p style="text-align:center"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong>INTRODUCTION: </strong><span style="background-color:white"><span style="color:#212121">Atrial Fibrillation (AF) is the most frequent arrhythmia in the world with an exponentially increasing prevalence. Pulmonary veins (PV) are the primary triggering sites for AF and pulmonary veins isolation (PVI) </span></span><span style="background-color:white"><span style="color:#2a2a2a">is currently the standard therapy alongside pharmacological treatment and should be considered as first-line treatment. Pulsed-field</span></span><span style="background-color:white">ablation (PFA) is a novel ablation modality that involves the application of electrical pulses causing cellular death, with preferential tissue specificity.</span></span></span></span></p>

<p style="text-align:center"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="background-color:white">AIM:</span></strong><span style="background-color:white"> In this study, we evaluated </span>the safety and efficacy of single-shot PFA in AF patients.</span></span></span></p>

<p style="text-align:center"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong>METHODS: </strong>Single-center registry of consecutive patients undergoing PVI using the pentaspline <span style="background-color:white">PFA catheter </span>(all with CARTO&reg;3D system v.7 and high-density mapping), <span style="background-color:white">between June </span>2022 and November 2023. Data on demographics, procedural characteristics, and electrocardiographic recurrence (assessed after a 3-month blanking period) were analyzed.</span></span></span></p>

<p style="text-align:center"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong>RESULTS: </strong>152 consecutive patients were included (63 <span style="font-family:Symbol">&plusmn;</span> 10 years, 57% male), with a mean CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 2<span style="font-family:Symbol">&plusmn;</span>1 points, median LVEF of 60% (IQR 59-65%), and a median CT-scan derived left atrial volume index of 56 mL/m<sup>2</sup>(IQR 44-69 mL/m<sup>2</sup>). A total of 40% had non-paroxysmal AF and a redo procedure was performed in 17% of patients.</span></span></span></p>

<p style="text-align:center"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">The median procedure time was 78 min (IQR 58-111 min) and fluoroscopy time was 11.6 min (IQR 8.2-15.6 min). Additionally, posterior wall isolation (PWI) was performed in 63 patients (41%). There were no esophageal complications, phrenic nerve injuries, cerebrovascular events, or procedure-related deaths. Two patients (1.3%) experienced acute cardiac tamponade, immediately treated with pericardiocentesis. Other complications were primarily vascular, in 5% of cases (4 femoral hematomas, 3 femoral pseudoaneurysms, 1 arteriovenous fistula). Over 293 (IQR 170 - 394) days of follow-up, considering electrocardiographic recurrence, 12% of patients had AF recurrence (5 with paroxysmal AF and 10 with persistent AF). These patients were older (69 <span style="font-family:Symbol">&plusmn;</span> 7y vs. 62 <span style="font-family:Symbol">&plusmn;</span> 11y, p=0.016), were more likely to undergo a redo procedure (33 vs. 8%, p=0.004), and had a higher percentage of posterior wall isolation (21 vs. 8%, p=0.038).</span></span></span></p>

<p style="text-align:center"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="color:black">CONCLUSIONS: </span></strong><span style="background-color:white">PFA for PVI wall ablation is safe and effective</span>, w<span style="background-color:white">ith 100% intraprocedural technical success, a low rate of complications, and a high percentage of patients free from AF in the short-term.</span></span></span></span></p>