EP News: Clinical

  • N.A. Mark Estes III
    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.
    UPMC Heart and Vascular Institute, Presbyterian Hospital, Pittsburgh, Pennsylvania
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Published:August 26, 2019DOI:
      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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