One-year follow-up of patients with persistent atrial fibrillation after Farapulse ablation - comparison of two ablation strategies
S Misikova, K Zdravecky, J Zembjak, J FarkasAbstract
Introduction
Pulsed-field ablation (PFA) represents an alternative energy source for atrial fibrillation (AF) ablation. Although pulmonary vein isolation (PVI) remains the cornerstone of ablation, the design of some PFA catheters allows for additional ablation of the posterior left atrial wall. The aim of this study was to assess the incidence of AF recurrence in patients with persistent AF depending on the ablation strategy used.
Methods
The study included 171 patients with persistent AF (M/F 130/41), with a mean age of 63 ± 8 years. Catheter ablation was performed using the Farapulse system under fluoroscopic guidance and with intracardiac echocardiography. The first group consisted of 22 patients who underwent PVI only; the second group included 149 patients whom additionally was posterior wall ablation performed. After the procedure, most patients discontinued antiarrhythmic drugs except for beta-blockers. Patients were followed at 3, 6, and 12 months after the procedure. A 24-hour Holter ECG was performed in 95% of patients (three times during the year), while 5% had a 7-day ECG recorder.
Results
Based on medical history, clinical status, and ECG monitoring, maintenance of sinus rhythm without recurrence of symptomatic atrial arrhythmia was observed in groups 1 vs. 2 at 3 months in 85% vs. 86%, at 6 months in 91% in both groups, and at 12 months in 90% vs. 82% of patients (p = 0.156). No major periprocedural complications were recorded. Fluoroscopy time did not differ between groups (11 vs. 13 minutes), but procedural time was significantly longer in the group with posterior wall ablation (65 vs. 72 minutes, p = 0.020).
Conclusion
In a one-year follow-up of patients with persistent AF, extending ablation to include posterior left atrial wall lines did not reduce atrial arrhythmia recurrence. No increase in periprocedural complications was observed. Further studies and longer follow-up are warranted to determine the optimal Farapulse ablation strategy in patients with persistent AF.