Focal Pulsed Field Ablation and Ultrahigh-density Mapping - Versatile Tools for All Atrial Arrhythmias? Initial Procedural Experiences

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2023 May 30

PMID 37249807

Authors

Martin H Ruwald

Arne Johannessen

Morten Lock Hansen

Martin Haugdal

Rene Worck

Jim Hansen

Affiliations

Soon will be listed here.

Abstract

Background: Focal pulsed field ablation (FPFA) is a novel and promising method of cardiac ablation. The aim of this study was to report the feasibility, short-term safety, and procedural findings for a broad spectrum of ablated atrial arrhythmias.

Methods: Patients (n = 51) scheduled for ablation of atrial arrhythmias were prospectively included and underwent FPFA using the Galvanize CENTAURI generator with energy delivery through commercially available ablation catheters with ultrahigh-density (UHDx) 3D electroanatomic voltage/local activation time map evaluations. Workflow, procedural data, and peri-procedural technical errors and complications are described.

Results: Planned ablation strategy was achieved with FPFA-only in 48/51 (94%) of the cases. Ablation strategy was first-time pulmonary vein isolation (PVI) in 17/51 (36%), repeat ablation in 18/51 (38%), PVI + in 13/51 (28%), and cavotricuspid isthmus block (CTI)-only in 3/51 (6%). The mean procedure time was 104 ± 31 min (first-time PVI), 114 ± 26 min (repeat procedure), 152 ± 36 min (PVI +), and 62 ± 17 min (CTI). Mean UHDx mapping time to assess lesion formation and block after ablation was 7 ± 4 min with 5485 ± 4809 points. First pass acute (linear) isolation with bidirectional block for anatomical lesion sets was 120/124 (97%) for all PVs, 17/17 (100%) for (any) isthmus, and 14/17 (82%) for left atrium posterior wall (LAPW). We observed several time-consuming integration errors with the used ablation system (mean 3.4 ± 3.7 errors/procedure), one transient inferior ST elevation when ablating CTI resolved by intravenous nitroglycerine and one transient AV block requiring temporary pacing for > 24 h.

Conclusions: FPFA was a highly versatile method to treat atrial arrhythmias with high first-pass efficiency. UHDx revealed acute homogenous low-voltage lesions in ablated areas. More data is needed to establish lesion durability and limitations of FPFA.

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References

Kistler P, Chieng D, Sugumar H, Ling L, Segan L, Azzopardi S . Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA Randomized Clinical Trial. JAMA. 2023; 329(2):127-135. PMC: 9856612. DOI: 10.1001/jama.2022.23722. View

Worck R, Sorensen S, Johannessen A, Ruwald M, Hansen M, Haugdal M . Posterior wall isolation in persistent atrial fibrillation. Long-term outcomes of a repeat procedure strategy. J Interv Card Electrophysiol. 2022; 66(4):971-979. DOI: 10.1007/s10840-022-01402-x. View

Verma A, Haines D, Boersma L, Sood N, Natale A, Marchlinski F . Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial. Circulation. 2023; 147(19):1422-1432. PMC: 10158608. DOI: 10.1161/CIRCULATIONAHA.123.063988. View

Worck R, Sorensen S, Johannessen A, Ruwald M, Haugdal M, Hansen J . Posterior wall isolation in persistent atrial fibrillation feasibility, safety, durability, and efficacy. J Cardiovasc Electrophysiol. 2022; 33(8):1667-1674. PMC: 9543717. DOI: 10.1111/jce.15556. View

Phlips T, Verhaeghe L, Antole N, Koopman P, Vijgen J . Pulsed field ablation using a focal contact force catheter allowed successful ablation of a focal right atrial tachycardia in the proximity of the phrenic nerve. HeartRhythm Case Rep. 2023; 9(7):434-436. PMC: 10363427. DOI: 10.1016/j.hrcr.2023.03.016. View

Ruwald M, Johannessen A, Hansen M, Worck R, Hansen J . Pulsed field ablation of the cavotricuspid isthmus using a multispline-electrode pulsed field ablation catheter. HeartRhythm Case Rep. 2022; 8(3):147-150. PMC: 9039561. DOI: 10.1016/j.hrcr.2021.12.009. View

Reddy V, Petru J, Funasako M, Kopriva K, Hala P, Chovanec M . Coronary Arterial Spasm During Pulsed Field Ablation to Treat Atrial Fibrillation. Circulation. 2022; 146(24):1808-1819. DOI: 10.1161/CIRCULATIONAHA.122.061497. View

Neven K, van Es R, van Driel V, van Wessel H, Fidder H, Vink A . Acute and Long-Term Effects of Full-Power Electroporation Ablation Directly on the Porcine Esophagus. Circ Arrhythm Electrophysiol. 2017; 10(5). DOI: 10.1161/CIRCEP.116.004672. View

Reddy V, Neuzil P, Koruth J, Petru J, Funosako M, Cochet H . Pulsed Field Ablation for Pulmonary Vein Isolation in Atrial Fibrillation. J Am Coll Cardiol. 2019; 74(3):315-326. DOI: 10.1016/j.jacc.2019.04.021. View

10.

Ruwald M, Johannessen A, Hansen M, Haugdal M, Worck R, Hansen J . Utility of High-Density 3D-Bipolar Voltage Map After Pulmonary Vein Isolation by Pulsed-Field Ablation. JACC Clin Electrophysiol. 2023; 9(4):588-590. DOI: 10.1016/j.jacep.2022.11.030. View

11.

Bohnen M, Weber R, Minners J, Jadidi A, Eichenlaub M, Neumann F . Characterization of circumferential antral pulmonary vein isolation areas resulting from pulsed-field catheter ablation. Europace. 2022; 25(1):65-73. PMC: 10103571. DOI: 10.1093/europace/euac111. View

12.

Koruth J, Kuroki K, Kawamura I, Brose R, Viswanathan R, Buck E . Pulsed Field Ablation Versus Radiofrequency Ablation: Esophageal Injury in a Novel Porcine Model. Circ Arrhythm Electrophysiol. 2020; 13(3):e008303. PMC: 7069397. DOI: 10.1161/CIRCEP.119.008303. View

13.

Duytschaever M, De Potter T, Grimaldi M, Anic A, Vijgen J, Neuzil P . Paroxysmal Atrial Fibrillation Ablation Using a Novel Variable-Loop Biphasic Pulsed Field Ablation Catheter Integrated With a 3-Dimensional Mapping System: 1-Year Outcomes of the Multicenter inspIRE Study. Circ Arrhythm Electrophysiol. 2023; 16(3):e011780. PMC: 10026968. DOI: 10.1161/CIRCEP.122.011780. View

14.

Ruwald M, Johannessen A, Hansen M, Haugdal M, Worck R, Hansen J . Pulsed field ablation in real-world atrial fibrillation patients: clinical recurrence, operator learning curve and re-do procedural findings. J Interv Card Electrophysiol. 2023; 66(8):1837-1848. DOI: 10.1007/s10840-023-01495-y. View

15.

Schmidt B, Bordignon S, Tohoku S, Chen S, Bologna F, Urbanek L . 5S Study: Safe and Simple Single Shot Pulmonary Vein Isolation With Pulsed Field Ablation Using Sedation. Circ Arrhythm Electrophysiol. 2022; 15(6):e010817. DOI: 10.1161/CIRCEP.121.010817. View

16.

Gunawardene M, Schaeffer B, Jularic M, Eickholt C, Maurer T, Akbulak R . Pulsed-field ablation combined with ultrahigh-density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations. J Cardiovasc Electrophysiol. 2022; 33(3):345-356. DOI: 10.1111/jce.15349. View

17.

Tohoku S, Chun K, Bordignon S, Chen S, Schaack D, Urbanek L . Findings from repeat ablation using high-density mapping after pulmonary vein isolation with pulsed field ablation. Europace. 2022; 25(2):433-440. PMC: 9935020. DOI: 10.1093/europace/euac211. View

18.

Verma A, Neal R, Evans J, Castellvi Q, Vachani A, Deneke T . Characteristics of pulsed electric field cardiac ablation porcine treatment zones with a focal catheter. J Cardiovasc Electrophysiol. 2022; 34(1):99-107. PMC: 10100505. DOI: 10.1111/jce.15734. View

19.

Ekanem E, Reddy V, Schmidt B, Reichlin T, Neven K, Metzner A . Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace. 2022; 24(8):1256-1266. PMC: 9435639. DOI: 10.1093/europace/euac050. View

20.

Koruth J, Kuroki K, Kawamura I, Stoffregen W, Dukkipati S, Neuzil P . Focal Pulsed Field Ablation for Pulmonary Vein Isolation and Linear Atrial Lesions: A Preclinical Assessment of Safety and Durability. Circ Arrhythm Electrophysiol. 2020; 13(6):e008716. DOI: 10.1161/CIRCEP.120.008716. View