Repeat procedures after pulsed field ablation for atrial fibrillation: MANIFEST-REDO study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
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Scherr Daniel, Turagam Mohit K, Maury Philippe, Blaauw Yuri, van der Voort Pepijn, Neuzil Petr, Reichlin Tobias, Metzner Andreas, Vijgen Johan, Kautzner Josef, Boveda Serge, Anic Ante, Hansen Jim, Manninger Martin, Sommer Philipp, Anselme Frederic, Willems Stephan, Deneke Thomas, Tilz Roland, Steven Daniel, Wakili Reza, Jais Pierre, Funasako Moritoshi, Arentz Thomas, Rollin Anne, Mulder Bart A, Ouss Alexandre, Petru Jan, Kueffer Thomas, Lemoine Marc D, Koopman Pieter, Peichl Petr, Adelino Raquel, Jurisic Zrinka, Ruwald Martin, Eberl Anna-Sophie, Sohns Christian, Savoure Arnaud, Nentwich Karin, Gunawardene Melanie, Heeger Christian-Hendrik, Sultan Arian, Bohnen Jan-Eric, Kupusovic Jana, Derval Nicolas, Lehrmann Heiko, Ekanem Emmanuel, Reddy Vivek Y
Аннотация
METHODS AND RESULTS: In the MANIFEST-REDO study, we investigated patients who underwent repeat ablation due to clinical recurrence-AF or atrial tachycardia (AT)-following first-ever PVI with a pentaspline PFA catheter (Farawave, Boston Scientific Inc.). At 22 centres, 427 patients (age 64 ± 11 years; 37% female) were included. Of note, the recurrent arrhythmia leading to the repeat ablation was paroxysmal AF (51%), persistent AF (30%), or AT (19%). At the repeat procedure, the PV reconnection rates were 30% (left superior pulmonary vein), 28% (left inferior pulmonary vein), 33% (right superior pulmonary vein), and 32% (right inferior pulmonary vein). In 45% of patients, all PVs were durably isolated at the beginning of the repeat procedure, with the previous use of any imaging or mapping modality being univariately associated with durable PVI. After a post-redo follow-up period of 284 (90-366) days, the primary effectiveness endpoint (freedom from documented AF/AT lasting ≥30 s after 3-month blanking without class I/III antiarrhythmic drugs or symptoms) was achieved in 65% of patients, with significant differences between groups (PAF 65% vs. PersAF 56% vs. AT 76%; P = 0.04). Persistent AF as recurrent arrhythmia after the initial PFA ablation predicted AT/AF recurrence after repeat ablation [hazard ratio 1.241 (95% confidence interval 1.534-1.005); P = 0.045]. The procedural complication rate was 2.8%.
CONCLUSION: In repeat procedures for AF/AT performed after an index procedure with PFA for AF, PV reconnections are not uncommon. Repeat procedures can be performed safely and with an acceptable subsequent success rate.