Pulsed field ablation technology for pulmonary vein and left atrial posterior wall isolation in patients with persistent atrial fibrillation

Marco Schiavone; Francesco Solimene; Massimo Moltrasio; Michela Casella; Stefano Bianchi; Saverio Iacopino; Antonio Rossillo; Vincenzo Schillaci; Gaetano Fassini; Paolo Compagnucci; Armando Salito; Pietro Rossi; Pasquale Filannino; Ruggero Maggio; Sakis Themistoklakis; Claudio Pandozi; Francesco Caprioglio; Maurizio Malacrida; Antonio Dello Russo; Claudio Tondo

doi:10.1111/jce.16246

Pulsed field ablation technology for pulmonary vein and left atrial posterior wall isolation in patients with persistent atrial fibrillation

J Cardiovasc Electrophysiol. 2024 Mar 22. doi: 10.1111/jce.16246. Online ahead of print.

Authors

Marco Schiavone^{1

2}, Francesco Solimene^{3

4}, Massimo Moltrasio¹, Michela Casella^{5

6}, Stefano Bianchi⁷, Saverio Iacopino⁸, Antonio Rossillo⁹, Vincenzo Schillaci³, Gaetano Fassini¹, Paolo Compagnucci^{4

5}, Armando Salito³, Pietro Rossi⁷, Pasquale Filannino⁸, Ruggero Maggio¹⁰, Sakis Themistoklakis¹¹, Claudio Pandozi¹², Francesco Caprioglio⁹, Maurizio Malacrida¹³, Antonio Dello Russo^{4

5}, Claudio Tondo^{1

14}

Affiliations

¹ Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
² Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
³ Montevergine Clinic, Mercogliano, Avellino, Italy.
⁴ Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
⁵ Department of Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy.
⁶ Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
⁷ Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy.
⁸ Maria Cecilia Hospital, Cotignola, Italy.
⁹ San Bortolo Hospital, Vicenza, Italy.
¹⁰ Degli Infermi Hospital, Rivoli, Italy.
¹¹ Dell'Angelo Hospital, Mestre, Italy.
¹² San Filippo Neri Hospital, Rome, Italy.
¹³ Boston Scientific, Milan, Italy.
¹⁴ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

PMID: 38519418
DOI: 10.1111/jce.16246

Abstract

Introduction: Limited data exist on pulsed-field ablation (PFA) in patients with persistent atrial fibrillation (PeAF) undergoing left atrial posterior wall isolation (LAPWI).

Methods: 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^TM-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.

Results: 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.

Conclusion: 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.

Keywords: atrial fibrillation; electroporation; left atrial posterior wall isolation; pulsed‐field ablation.