Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
J Cardiovasc Electrophysiol. 2024 Jun;35(6):1101-1111. doi: 10.1111/jce.16246. Epub 2024 Mar 22.
Limited data exist on pulsed-field ablation (PFA) in patients with persistent atrial fibrillation (PeAF) undergoing left atrial posterior wall isolation (LAPWI).
The Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA) prospective registry included consecutive patients referred for PeAF catheter ablation at 9 Italian centers, treated with the FARAPULSE-PFA system. The primary efficacy and safety study endpoints were the acute LAPWI rate, freedom from arrhythmic recurrences and the incidence of major periprocedural complications. Patients undergoing pulmonary vein isolation (PVI) alone, PWI + LAPWI and redo procedures were compared.
Among 249 patients, 21.7% had long-standing PeAF, 79.5% were male; mean age was 63 ± 9 years. LAPWI was performed in 57.6% of cases, with 15.3% being redo procedures. Median skin-to-skin times (PVI-only 68 [60-90] vs. PVI + LAPWI 70 [59-88] mins) did not differ between groups. 45.8% LAPWI cases were approached with a 3D-mapping system, and 37.3% with intracardiac echocardiography. LAPWI was achieved in all patients by means of PFA alone, in 88.8% cases at first pass. LAPWI was validated either by an Ultrahigh-density mapping system or by recording electrical activity + pacing maneuvers. No major complications occurred, while 2.4% minor complications were detected. During a median follow-up of 273 [191-379] days, 41 patients (16.5%) experienced an arrhythmic recurrence after the 90-day blanking period, with a mean time to recurrence of 223 ± 100 days and no differences among ablation strategies.
LAPWI with PFA demonstrates feasibility, rapidity, and safety in real-world practice, offering a viable alternative for PeAF patients. LAPWI is achievable even with a fluoroscopy-only method and does not significantly extend overall procedural times.
在接受左心房后壁隔离（LAPWI）的持续性心房颤动（PeAF）患者中，脉冲场消融（PFA）的数据有限。
先进技术在临床实践中成功消融心房颤动（ATHENA）前瞻性登记包括意大利 9 个中心连续转介的 PeAF 导管消融患者，使用 FARAPULSE-PFA 系统治疗。主要疗效和安全性研究终点是急性 LAPWI 率、无心律失常复发和主要围手术期并发症的发生率。比较了仅行肺静脉隔离（PVI）、PWI+LAPWI 和再次手术的患者。
在 249 名患者中，21.7%患有长期持续性房颤，79.5%为男性；平均年龄为 63±9 岁。57.6%的患者行 LAPWI，其中 15.3%为再次手术。单纯 PVI 组与 PVI+LAPWI 组的中位皮肤-皮肤时间（68[60-90]与 70[59-88]分钟）无差异。45.8%的 LAPWI 病例采用 3D 标测系统，37.3%采用心内超声。所有患者均采用 PFA 单独进行 LAPWI，88.8%的患者首次通过。LAPWI 通过超高密度标测系统或记录电活动+起搏操作验证。无重大并发症，仅发现 2.4%的小并发症。中位随访 273[191-379]天，41 名患者（16.5%）在 90 天空白期后发生心律失常复发，平均复发时间为 223±100 天，不同消融策略之间无差异。
在真实世界实践中，PFA 进行 LAPWI 具有可行性、快速性和安全性，为 PeAF 患者提供了一种可行的替代方案。即使采用仅透视的方法，LAPWI 也是可行的，且不会显著延长总手术时间。
