Journal of cardiovascular electrophysiology · 2025
Acute Efficacy of Pulsed-Field Ablation of the Mitral Isthmus Using a Pentaspline Catheter and Two Different Ablation Settings.
СтатьяСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Hornof Josef, Hozman Marek, Heřman Dalibor, Romanenko Oleksii, Hassouna Sabri, Veselá Jana, Filipcová Věra, Povišer Lukáš, Karch Jakub, Hozmanová Jana, Znojilová Lucie, Molová Anna, Pěnkava Vojtěch, Osmančík Pavel
Аннотация
INTRODUCTION: There is limited data regarding the use of pulsed-field ablation (PFA) for mitral isthmus (MI) ablation in patients with non-paroxysmal atrial fibrillation (AF). Our aim was to assess the acute efficacy of MI ablation using a pentaspline PFA catheter with two different ablation settings.
METHODS: Patients with AF undergoing ablation were consecutively enrolled. All patients underwent pulmonary vein isolation and left atrial posterior wall ablation. MI ablation was performed in up to 4 series (9 PFA applications each) in Cohort A, or in up to 3 series (20 PFA applications each) in Cohort B. Each series was followed by a 20-min observation period to verify the durability of the MI block. The primary endpoints were a first-pass MI block and a final MI block after all ablation series.
RESULTS: Between September 2024 and June 2025, 70 patients were enrolled: 30 in Cohort A and 40 in Cohort B. A first-pass MI block was achieved in 10 (33.3%) patients in Cohort A and 28 (70%) patients in Cohort B (p = 0.003). A final MI block was present in 27 (90%) and 35 (87.5%) patients in Cohort A and B, respectively (p = 1.00). The median reconduction time was 6 min (IQR 2.8-9.4) in Cohort A and 5 min (IQR 2.6-8.7) in Cohort B. No major complications occurred.
CONCLUSION: Using series of 20 PFA applications increased the success rate of a first-pass MI block to 70%. An observation period is recommended to verify the durability of MI block in PFA.
CLINICAL TRIAL REGISTRATION: NCT06803238.
METHODS: Patients with AF undergoing ablation were consecutively enrolled. All patients underwent pulmonary vein isolation and left atrial posterior wall ablation. MI ablation was performed in up to 4 series (9 PFA applications each) in Cohort A, or in up to 3 series (20 PFA applications each) in Cohort B. Each series was followed by a 20-min observation period to verify the durability of the MI block. The primary endpoints were a first-pass MI block and a final MI block after all ablation series.
RESULTS: Between September 2024 and June 2025, 70 patients were enrolled: 30 in Cohort A and 40 in Cohort B. A first-pass MI block was achieved in 10 (33.3%) patients in Cohort A and 28 (70%) patients in Cohort B (p = 0.003). A final MI block was present in 27 (90%) and 35 (87.5%) patients in Cohort A and B, respectively (p = 1.00). The median reconduction time was 6 min (IQR 2.8-9.4) in Cohort A and 5 min (IQR 2.6-8.7) in Cohort B. No major complications occurred.
CONCLUSION: Using series of 20 PFA applications increased the success rate of a first-pass MI block to 70%. An observation period is recommended to verify the durability of MI block in PFA.
CLINICAL TRIAL REGISTRATION: NCT06803238.