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EP News: Clinical

  • N.A. Mark Estes III
    Correspondence
    Address reprint requests and correspondence: Dr N.A. Mark Estes III, UPMC Heart and Vascular Institute, Presbyterian Hospital, 200 Lothrop St, 3rd Floor South Tower (WE352.1), Pittsburgh, PA 15213.
    Affiliations
    UPMC Heart and Vascular Institute, Presbyterian Hospital, Pittsburgh, Pennsylvania
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Published:August 26, 2019DOI:https://doi.org/10.1016/j.hrthm.2019.08.007
      Reddy et al (Am Coll Cardiol 2019;74:315, PMID 31085321) evaluated whether pulse field ablation (PFA) allows durable pulmonary vein (PV) isolation without damage to collateral structures. Two trials assessed the safety and effectiveness of catheter-based PFA in paroxysmal atrial fibrillation. Invasive electrophysiological mapping was repeated after 3 months to assess the durability of PV isolation. In 81 patients, all PVs were acutely isolated by monophasic (n = 15) or biphasic (n = 66) PFA with ≤3 minutes elapsed delivery per patient, a skin-to-skin procedure time of 92.2 ± 27.4 minutes, and a fluoroscopy time of 13.1 ± 7.6 minutes. With successive waveform refinement, durability at 3 months improved from 18% to 100% of patients with all PVs isolated. Beyond 1 procedure-related pericardial tamponade, there were no additional primary adverse events over the 120-day median follow-up. The 12-month Kaplan-Meier estimate of freedom from arrhythmia was 87.4% ± 5.6%. The authors conclude that in the first-in-human trials, PFA preferentially affected myocardial tissue, allowing facile ultrarapid PV isolation with excellent durability and chronic safety.
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