Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N Interstate Hwy 35, Austin, TX 78705, USA.
Europace. 2024 Oct 3;26(10). doi: 10.1093/europace/euae246.
Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF maintenance. We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via a pentaspline pulsed field ablation (PFA) catheter in persistent AF sustained beyond 6 months (PerAF > 6 m) and long-standing persistent AF (LSPAF).
The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia regionalization and ablation (Stage 3). Seventy-two [age:68 ± 10years, 61.1%males; AF history: 25 (18-45) months] patients with PerAF > 6 m (52.8%) and LSPAF (47.2%) underwent their first PFA via the FarapulseTM system. LA substrate ablation (Stage 1 and 2) led to AF termination in 95.8% of patients. AF organized into a left-sided atrial flutter (AFlu) in 46 (74.2%) patients. The PFA catheter was used to identify LA sites showing diastolic, low-voltage electrograms and entrainment from its splines was performed to confirm the pacing site was inside the AFlu circuit. Left AFlu termination was achieved in all cases via PFA delivery. Total procedural and LA dwell times were 112 ± 25 min and 59 ± 22 min, respectively. Major complications occurred in 2 (2.8%) patients. Single-procedure success rate was 74.6% after 14.9 ± 2.7 months of follow-up; AF-free survival was 89.2%.
In our cohort, PFA-based AF substrate ablation led to AF termination in 95.8% of cases. Very favourable clinical outcomes were observed during >1 year of follow-up.
非阵发性心房颤动（AF）的节律控制极具挑战性，这是由于心律失常的持续存在促进了心房基质的改变和 AF 的维持。我们描述了一种针对持续性 AF （PerAF > 6m）和长期持续性 AF （LSPAF）的多左心房（LA）部位的定制消融策略，该策略通过五导联脉冲场消融（PFA）导管实现。
消融方案包括以下阶段：肺静脉窦和后壁隔离加前房顶线消融（第 1 阶段）；电描记图引导下的基质消融（第 2 阶段）；房性心动过速区域化和消融（第 3 阶段）。72 例（年龄：68 ± 10 岁，61.1%为男性；AF 病史：25（18-45）个月）接受过首次 FarapulseTM 系统 PFA 治疗的 PerAF > 6m（52.8%）和 LSPAF（47.2%）患者。LA 基质消融（第 1 阶段和第 2 阶段）使 95.8%的患者的 AF 终止。46 例（74.2%）患者的 AF 组织为左侧心房扑动（AFLu）。使用 PFA 导管识别 LA 部位显示舒张期、低电压电图，并从其叶片上进行起搏标测以确认起搏部位位于 AFLu 环内。通过 PFA 输送，所有病例均终止左 AFLu。总手术和 LA 停留时间分别为 112 ± 25 分钟和 59 ± 22 分钟。2 例（2.8%）患者发生重大并发症。在 14.9 ± 2.7 个月的随访后，单次手术成功率为 74.6%；AF 无复发生存率为 89.2%。
在我们的队列中，基于 PFA 的 AF 基质消融使 95.8%的病例中的 AF 终止。在超过 1 年的随访期间观察到非常有利的临床结果。
