![]() ![]() After transseptal puncture, a 13-F steerable sheath (Faradrive, Farapulse Inc.) was advanced into the left atrium via a guide wire. 2.2 PFA procedureĪll patients underwent PFA under deep sedation using propofol and fentanyl. Anticoagulation was initiated at least 4 weeks before the procedure and continued for at least 3 months afterwards. Patients with paroxysmal as well as persistent AF were considered eligible for the procedure. In this study, we investigated 14 patients who underwent a re-ablation procedure within one year after being treated for symptomatic AF using PFA between April 2022 and October 2022 at the University Medical Center Groningen (UMCG), the Netherlands, the University Hospital Graz, Austria, and Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Germany. We provide an overview with patient characteristics and procedural findings of our first redo procedure for an atrial arrhythmia after an index procedure with PFA. In the present study, we present a series of 14 patients in whom a recurrence of AT/AFL/AF was observed within the first year after PVI with PFA. In addition, questions remain regarding recurrent atrial flutter/tachycardia (AFL/AT) due to potential iatrogenic atrial channels following single-shot PFA. However, one of the major issues to address is long-term results of the technique. PFA’s unique ability of selective electroporation and potential for minimal adnexal injury opens new, promising horizons into catheter ablation of AF. Myocardium has a lower threshold for tissue necrosis and this allows to preferentially ablate myocardial tissue without compromising surrounding anatomical structures such as oesophagus, blood vessels or nerve fibres. Human tissues differ by their affinity to dielectric cell membrane breakdown. Pulsed field ablation (PFA) is a novel non-thermal ablation modality which applies electroporation to destabilize the cell membranes and form nanoscale pores, eventually resulting in irreversible damage and cell death. Pulmonary vein isolation (PVI) has become the mainstay of AF management if a rhythm control strategy is chosen. Concomitant (35.7%) or isolated (14.3%) AFL/AT recurrence was observed in 50% of patients.Ītrial fibrillation (AF) is the most common sustained arrhythmia conferring substantial burden of cardiovascular morbidity, mortality and impaired quality of life. The predominant recurrent arrhythmia following PVI-only was AF. Conclusionsĭurable PVI (all PV’s isolated) was observed in over one-third of patients at re-do. Patients with only AFL/AT had no reconnection of PVs, and the substrate was successfully ablated. All 7 patients with zero or one reconnection with AF recurrence received additional/repeat posterior-wall-isolation during re-ablation, while in the others, PVs were re-isolated. Reconnection in zero, one, two or three PVs was found in 35.7%, 21.4%, 14.3%, and 28.6% of patients, respectively. In the remaining 2 patients, one had a (box-dependent) AFL, and one had an atypical AT. Twelve (85.7%) patients suffered AF recurrence and 5/12 had concomitant AFL. Three patients received additional posterior-wall-isolation during index PFA. ![]() Mean time-to-recurrence was 4.9☑.9 months. Initial indication was paroxysmal-AF in 7 patients, persistent-AF in 6 and long-standing-persistent-AF in one patient. Of 447 patients undergoing index PVI with PFA, 14 patients (age: 61.9☑0.8 years 7 (50.0%) males left atrial volume index ( n=10): 39.4☑4.6 mL/m 2) were referred for redo-ablation. We report electrophysiological findings and ablation strategy during redo-ablation. We investigated patients who underwent redo-ablation due to recurrent AF/atrial-flutter or tachycardia (AFL/AT) following PVI with PFA. Currently, little is known about the durability of PFA ablation lesions. Pulsed field ablation (PFA) is a novel ablation technology recently adopted in the treatment of atrial fibrillation (AF). ![]()
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