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CLEAR FILTERS
Pulsed field ablation: a new era in atrial fibrillation treatment?
Session:
Comunicações Orais - Sessão 11 - Ablação de fibrilhação auricular
Speaker:
Ana Lobato de Faria Abrantes
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:
Ana Lobato De Faria Abrantes; Ana Margarida Martins; Catarina Oliveira; Ana Beatriz Garcia; Miguel Azaredo Raposo; Ana Bernardes; Nelson Cunha; Afonso Nunes Ferreira; Gustavo Lima da Silva; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Pulsed field ablation (PFA) is a new technology based on the use of high-voltage electrical fields to induce cell death by electroporation. Cardiomyocytes were found highly sensitive to this form of energy, creating the theoretical possibility of a safer, more effective and faster mode of AF ablation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> To compare the efficacy, safety and procedural duration of PFA and cryoablation (CA) for PVI.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Single-center prospective study of AF patients (pts) submitted to PVI with either PFA (Farapulse system) or CA from January to November 2023. Ablation strategy consisted in PVI, complemented with cavotricuspid isthmus (CTI) ablation in pts with concomitant atrial flutter. Propensity score matching based on AF type and CHA2DS2-VASc score was used to generate comparable groups. Acute success was defined by the isolation of all PV. Safety was assessed by the occurrence of major and minor complications. Procedural duration was defined by the skin-to-skin total time. Student T and chi-square tests were used for the comparison of continuous and categorical variables, respectively.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> From 152 pts submitted to PVI, 118 pts were selected based on propensity score matching (1:1), 70% males, 66±13 years, CHA2DS2-VASc 2.5±1.2, with paroxysmal, short-duration or long-standing persistent AF in 71%, 17% and 12%, respectively, without differences between groups. Between groups, no differences were found in respect to acute success (PFA: 98.3% vs. CA: 100), major complications (PFA: 3.4% vs. CA: 1.7%) or minor complications (PFA: 1.7% vs. 3.4%) - Table. Procedure time, which included CTI ablation in 22%, was significantly lower in pts submitted to PFA (53±25 vs. 83±31 min, p<0.001) with similar fluoroscopy times (PFA: 7.7±10.7 vs CA: 8.1±8.5 p=0.17). One pt submitted to PFA died 4 days after the procedure due to femoral hemorrhage complicated with hemorrhagic shock.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> PFA is a promising new ablation technology, allowing very fast PVI procedures.</span></span></span></p>
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