Impact of pre-procedural imaging in pulsed-field ablation for the treatment of atrial fibrillation
F Jordan, N F Formenti, D Spreen, C Isenegger, J Bruegger, A S Bettelini, C Moser, R Stump, N Schaerli, P Krisai, S Knecht, F Mahfoud, C Sticherling, M Kuehne, P BadertscherAbstract
Introduction
Pulsed-field ablation (PFA) is an effective modality for pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). Pre-procedural computed tomography (CT) is commonly used for anatomical orientation, yet its incremental value in contemporary PFA workflows remains uncertain.
Aim
To evaluate the impact of omitting pre-procedural CT on procedural efficiency, safety, and arrhythmia outcomes in PFA for AF.
Methods
Patients undergoing first-time PVI only with PFA using a pentaspline catheter without electroanatomical mapping were prospectively enrolled at a tertiary center. Patients were treated in two consecutive protocol phases: initially with a standard protocol using CT-based anatomy, and subsequently with a protocol performed without pre-procedural imaging.
Results
A total of 333 patients (median age 66 [58–73] years, 33% female) were included: 155 (47%) with imaging and 178 (53%) without imaging. Total procedure duration was slightly shorter without imaging (30 [25–35] vs 33 [25–41] minutes, p = 0.034). Left atrial dwell time was similar (18 [13–21] vs 17 [13–24] minutes, p = 0.598). Fluoroscopy time was lower without imaging (7 [5–9] vs 9 [6–12] minutes, p < 0.001). Complications were infrequent (Total 2, 0.6% overall). During a median follow-up of 300 [193–581] days, arrhythmia recurrence did not differ significantly (20% vs. 27%; log-rank p = 0.342, HR 0.80).
Conclusion
In this pilot experience, procedural performance and arrhythmia outcomes were similar whether pre-procedural CT imaging was used. A dedicated non-inferiority randomized trial is required to validate these observations.Graphical Abstract