Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond
Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from Sept...
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MDPI AG
2024-11-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/11/11/356 |
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| author | Julian Cheong Kiat Tay Jannah Lee Tarranza Shaw Yang Chia Xuan Ming Pung Germaine Jie Min Loo Hooi Khee Teo Colin Yeo Vern Hsen Tan Eric Tien Siang Lim Daniel Thuan Tee Chong Kah Leng Ho Chi Keong Ching |
| author_facet | Julian Cheong Kiat Tay Jannah Lee Tarranza Shaw Yang Chia Xuan Ming Pung Germaine Jie Min Loo Hooi Khee Teo Colin Yeo Vern Hsen Tan Eric Tien Siang Lim Daniel Thuan Tee Chong Kah Leng Ho Chi Keong Ching |
| author_sort | Julian Cheong Kiat Tay |
| collection | DOAJ |
| description | Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all <i>p</i> < 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all <i>p</i> > 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3–97.3] and 82.8% [95% CI, 68.1–97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications. |
| format | Article |
| id | doaj-art-140719cbd2a6498191cd16ef71d495e0 |
| institution | OA Journals |
| issn | 2308-3425 |
| language | English |
| publishDate | 2024-11-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-140719cbd2a6498191cd16ef71d495e02025-08-20T02:04:52ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252024-11-01111135610.3390/jcdd11110356Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and BeyondJulian Cheong Kiat Tay0Jannah Lee Tarranza1Shaw Yang Chia2Xuan Ming Pung3Germaine Jie Min Loo4Hooi Khee Teo5Colin Yeo6Vern Hsen Tan7Eric Tien Siang Lim8Daniel Thuan Tee Chong9Kah Leng Ho10Chi Keong Ching11Department of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, Changi, General Hospital, Singapore 529889, SingaporeDepartment of Cardiology, Changi, General Hospital, Singapore 529889, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore 169609, SingaporeRegional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all <i>p</i> < 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all <i>p</i> > 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3–97.3] and 82.8% [95% CI, 68.1–97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications.https://www.mdpi.com/2308-3425/11/11/356pulsed field ablationpulmonary vein isolationposterior wall ablation |
| spellingShingle | Julian Cheong Kiat Tay Jannah Lee Tarranza Shaw Yang Chia Xuan Ming Pung Germaine Jie Min Loo Hooi Khee Teo Colin Yeo Vern Hsen Tan Eric Tien Siang Lim Daniel Thuan Tee Chong Kah Leng Ho Chi Keong Ching Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond Journal of Cardiovascular Development and Disease pulsed field ablation pulmonary vein isolation posterior wall ablation |
| title | Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond |
| title_full | Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond |
| title_fullStr | Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond |
| title_full_unstemmed | Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond |
| title_short | Pulsed Field Ablation in Atrial Fibrillation: Initial Experience of the Efficacy and Safety in Pulmonary Vein Isolation and Beyond |
| title_sort | pulsed field ablation in atrial fibrillation initial experience of the efficacy and safety in pulmonary vein isolation and beyond |
| topic | pulsed field ablation pulmonary vein isolation posterior wall ablation |
| url | https://www.mdpi.com/2308-3425/11/11/356 |
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