Cardioangiologisches Centrum Bethanien CCB at Agaplesion Markus Krankenhaus, Medizinische Klinik III, Frankfurt am Main, Germany.
J Cardiovasc Electrophysiol. 2023 Dec;34(12):2425-2433. doi: 10.1111/jce.16083. Epub 2023 Sep 28.
Pulsed field ablation (PFA) is a new ablation technology for atrial fibrillation (AF). Data regarding early recurrences of atrial tachyarrhythmia (ERAT) after PFA-pulmonary vein isolation (PVI) are sparse.
Consecutive patients with symptomatic AF were enrolled to undergo PFA-PVI. A dedicated catheter delivering bipolar energy (1.9-2.0 kV) was used. Late recurrence (LR) was defined as documented AF/atrial tachycardia (AT) lasting more than 30 s after a 90-day blanking period.
Two hundred and thirty-one patients (42% female, age 69 ± 12, 55% paroxysmal AF [PAF]) were included in this analysis. Median follow-up time was 367 days (interquartile range: 253-400). Forty-six patients (21%) experienced ERAT after a median of 23 days (46% in PAF and 54% in persistent AF [persAF]). Kaplan-Meier estimated freedom of AF/AT was 74.2% at 1 year, 81.8% for PAF, and 64.8% for persAF (p = .0079). Of patients experiencing ERAT, an LR was observed in 54%. There was no significant difference of LR between those who presented with very early ERAT (0-45 days) and those with ERAT (46-90 days) (p = .57). In multivariate analysis, ERAT (hazard ratio [HR]: 3.370; 95% confidence interval [95% CI]: 1.851-6.136; p < .001) and female sex (HR: 2.048; 95% CI: 1.114-3.768; p = .021) were the only independent predictors for LR.
ERAT could be recorded in 21% of patients after PFA-PVI and was an independent predictor for LR. We found no difference in the rate of LRs among patients experiencing ERAT before or after 45 days.
脉冲场消融（PFA）是一种治疗心房颤动（AF）的新消融技术。关于 PFA-肺静脉隔离（PVI）后早期复发性房性心动过速（ERAT）的数据很少。
连续入组有症状的 AF 患者，行 PFA-PVI。使用专门的导管输送双极能量（1.9-2.0 kV）。晚期复发（LR）定义为在 90 天空白期后记录到持续 30 秒以上的 AF/房性心动过速（AT）。
本分析共纳入 231 例患者（42%为女性，年龄 69±12 岁，55%为阵发性 AF [PAF]）。中位随访时间为 367 天（四分位距：253-400）。46 例（21%）患者在中位时间 23 天后出现 ERAT（PAF 中 46%，持续性 AF [persAF]中 54%）。Kaplan-Meier 估计 1 年时 AF/AT 无复发率为 74.2%，PAF 为 81.8%，persAF 为 64.8%（p=0.0079）。发生 ERAT 的患者中，54%出现 LR。早期 ERAT（0-45 天）和 ERAT（46-90 天）患者的 LR 发生率无显著差异（p=0.57）。多变量分析显示，ERAT（风险比 [HR]：3.370；95%置信区间 [95%CI]：1.851-6.136；p<0.001）和女性（HR：2.048；95%CI：1.114-3.768；p=0.021）是 LR 的唯一独立预测因素。
PFA-PVI 后 21%的患者可记录到 ERAT，且是 LR 的独立预测因素。我们发现，ERAT 发生在 45 天之前或之后的患者中，LR 发生率无差异。
