Gunawardene Melanie A, Harloff Tim, Jularic Mario, Dickow Jannis, Wahedi Rahin, Anwar Omar, Wohlmuth Peter, Gessler Nele, Hartmann Jens, Willems Stephan
Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.
Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest.
Europace. 2024 Mar 30;26(4). doi: 10.1093/europace/euae072.
Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT.
Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P < 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11-7.65), P = 0.0473].
Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.
消融术后左房性心动过速（LAT）的导管消融（CA）可能具有挑战性。到目前为止，尚未将脉冲场消融（PFA）与用于LAT消融的标准逐点射频电流（RFC）能量进行比较。比较PFA与RFC在接受LAT-CA治疗的患者中的疗效。
前瞻性纳入连续接受LAT-CA治疗的患者（2021年9月至2023年2月）。在进行电解剖高密度标测后，使用五边形PFA导管或RFC进行消融。患者按1:1匹配。在假定的关键峡部部位进行消融，必要时进行额外消融。右房性心动过速（RAT）用RFC消融。评估急性和慢性成功率。共纳入56例患者（每组28例，年龄70±9岁，75%为男性）。共发生77次房性心动过速（67次LAT，10次RAT；77%为大折返），PFA组有32次LAT，RFC组有35次LAT。在所有LAT中，94%（PFA组）与91%（RFC组）在消融期间成功终止为窦性心律或另一种房性心动过速（P = 1.0）。手术时间较短（PFA：121±41分钟 vs. RFC：190±44分钟，P < 0.0001），PFA组透视时间较长（PFA：15±9分钟 vs. RFC：11±6分钟，P = 0.04）。无重大并发症。随访一年后，估计无心律失常生存率在PFA组为63%，在RFC组为87%，[风险比2.91（95%CI：1.11 - 7.65），P = 0.0473]。
使用五边形导管对消融术后LAT进行脉冲场消融是可行、安全且更快的，但与标准RFC消融相比，随访一年后效果较差。未来的导管设计和电场优化可能会进一步提高PFA治疗LAT的实用性和疗效。
