Incidence and risk factors of acute blood pressure drops during circular-array pulsed-field ablation for pulmonary vein isolation.

BACKGROUND

Data regarding acute blood pressure (BP) drops during pulsed-field ablation (PFA) for pulmonary vein isolation (PVI) are limited.

OBJECTIVE

This study aimed to determine the incidence and risk factors of acute BP drops during PFA-PVI.

METHODS

We retrospectively analyzed 50 consecutive patients who underwent PFA-PVI using a circular-array system (PulseSelect, Medtronic Inc). 4 predefined sequencing protocols were compared and categorized according to the first targeted pulmonary vein (PV). Systolic BP was recorded immediately after each application. A BP drop was defined as a >40 mm Hg decrease or an absolute value of <60 mm Hg; a severe BP drop was defined as one requiring intervention.

RESULTS

Among 1797 applications, BP drops occurred in 205 applications (11%), and 38 of 50 patients (76%) experienced at least 1 episode. Severe BP drops occurred in 30 applications (2%) in 16 patients (32%); 53% clustered in the left superior PV-first protocol. Coughing was significantly more frequent in applications with BP drops than in those without (54% vs 26%; P < .001). Across all protocols, systolic BP decreased after each application, with attenuation in magnitude as the sequence progressed (P < .001). In multivariable models, earlier application order and distal-segment applications were independently associated with BP drops, whereas severe BP drops were independently associated with left PV targeting. In sequence-stratified models, the first PV treated (applications 1-9) carried the highest risk, with a stepwise decline in risk across subsequent blocks.

CONCLUSION

Acute BP drops are common during circular-array PFA-PVI and occur predominantly during the first PV treatment.