Heart rhythm · 2026
Pulsed field ablation with a pentaspline catheter and concomitant left atrial appendage closure for long-standing persistent atrial fibrillation: Comparison with a radiofrequency cohort.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Schiavone Marco, La Fazia Vincenzo Mirco, Fassini Gaetano, Gasperetti Alessio, Mohanty Sanghamitra, Bianchini Lorenzo, Zhang Xiao-Dong, Moltrasio Massimo, Zito Elio, Marino Marco, Tundo Fabrizio, Forleo Giovanni B, di Biase Luigi, Natale Andrea, Tondo Claudio
Аннотация
BACKGROUND: Pulsed field ablation (PFA) is increasingly being adopted for atrial fibrillation (AF) ablation, but outcome data, when it is combined with left atrial appendage occlusion (LAAO), remain limited.
OBJECTIVE: We evaluated outcomes of extensive PFA combined with LAAO, compared with radiofrequency ablation plus LAAO in patients with long-standing persistent AF.
METHODS: In this observational, multicenter, propensity-matched study, 90 consecutive patients with drug-refractory, long-standing persistent AF underwent combined ablation (pulmonary veins, posterior wall, and LAA electrical isolation) plus LAAO (45 PFA, 45 RF). Matching was 1:1 based on age, CHA2DS2-VASc score, HAS-BLED score, and LAAO device. Follow-up was censored at 12 months.
RESULTS: Baseline characteristics were balanced after matching. Procedural time was shorter with PFA than RF (86.0 ± 6.8 vs 114.5 ± 11.5 minutes, P = 0.042). Acute LAAO success was 100% in both groups, with similar complication rates (1 pericardial effusion each). Overall peri-device leak (PDL) incidence was lower with PFA (8.9% vs 24.4%, P = 0.048), although clinically relevant leaks >3 mm were infrequent and comparable (0% vs 4.4%, P = 0.494). At 12 months, arrhythmic recurrences were numerically lower with PFA (22.2% vs 40.0%, P = 0.069; log-rank P = 0.093). No strokes or major bleeding occurred in the PFA cohort, whereas 1 non-cardioembolic stroke and 2 major bleeding events occurred in the RF group. In Cox regression, only AF duration >18 months predicted recurrence (hazard ratio = 3.27, 95% confidence interval 1.15-9.32; P = 0.027).
CONCLUSION: Extensive PFA, including LAA electrical isolation, combined with LAAO was feasible and safe, resulting in shorter procedures, fewer overall PDLs compared with RF but similar rate of PDL >3 mm.
OBJECTIVE: We evaluated outcomes of extensive PFA combined with LAAO, compared with radiofrequency ablation plus LAAO in patients with long-standing persistent AF.
METHODS: In this observational, multicenter, propensity-matched study, 90 consecutive patients with drug-refractory, long-standing persistent AF underwent combined ablation (pulmonary veins, posterior wall, and LAA electrical isolation) plus LAAO (45 PFA, 45 RF). Matching was 1:1 based on age, CHA2DS2-VASc score, HAS-BLED score, and LAAO device. Follow-up was censored at 12 months.
RESULTS: Baseline characteristics were balanced after matching. Procedural time was shorter with PFA than RF (86.0 ± 6.8 vs 114.5 ± 11.5 minutes, P = 0.042). Acute LAAO success was 100% in both groups, with similar complication rates (1 pericardial effusion each). Overall peri-device leak (PDL) incidence was lower with PFA (8.9% vs 24.4%, P = 0.048), although clinically relevant leaks >3 mm were infrequent and comparable (0% vs 4.4%, P = 0.494). At 12 months, arrhythmic recurrences were numerically lower with PFA (22.2% vs 40.0%, P = 0.069; log-rank P = 0.093). No strokes or major bleeding occurred in the PFA cohort, whereas 1 non-cardioembolic stroke and 2 major bleeding events occurred in the RF group. In Cox regression, only AF duration >18 months predicted recurrence (hazard ratio = 3.27, 95% confidence interval 1.15-9.32; P = 0.027).
CONCLUSION: Extensive PFA, including LAA electrical isolation, combined with LAAO was feasible and safe, resulting in shorter procedures, fewer overall PDLs compared with RF but similar rate of PDL >3 mm.