Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
38430087
DOI
10.1016/j.jacep.2024.01.017
PII: S2405-500X(24)00030-6
Knihovny.cz E-resources
- Keywords
- atrial fibrillation, posterior wall ablation, pulmonary vein isolation, pulsed field ablation,
- MeSH
- Atrial Fibrillation * surgery MeSH
- Catheter Ablation * methods adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Heart Atria * surgery MeSH
- Pulmonary Veins * surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. OBJECTIVES: This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). METHODS: In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. RESULTS: Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). CONCLUSIONS: In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.
Asklepios Hospital St Georg Hamburg Germany
Cardiology Department Na Homolce Hospital Homolka Hospital Prague Czech Republic
Catharina Hospital Eindhoven the Netherlands
Department for Cardiovascular Diseases University Hospital Center Split Split Croatia
Department of Cardiology Herlev Gentofte University Hospital Hellerup Denmark
Department of Cardiology Jessa Hospitals Hasselt Belgium
Department of Cardiology Rouen Hospital Rouen France
Department of Cardiology University Hospital Rangueil Toulouse France
Division of Cardiology Department of Internal Medicine Medical University of Graz Graz Austria
Heart Center Bad Neustadt Rhoen Clinic Campus Bad Neustadt Bad Neustadt an der Saale Germany
Heart Center University Hospital of Cologne Department for Electrophysiology Cologne Germany
Icahn School of Medicine at Mount Sinai New York New York USA
IHU LIRYC CHU Bordeaux University of Bordeaux Pessac France
IKEM Institute for Clinical and Experimental Medicine Prague Czech Republic
Inselspital Bern University Hospital University of Bern Bern Switzerland
MVZ CCB Frankfurt und Main Taunus GbR Frankfurt Germany
University Heart and Vascular Center University Medical Center Hamburg Eppendorf Hamburg Germany
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