A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-month success rates.

BACKGROUND

Focal pulsed field ablation (F-PFA) integrated in electroanatomic mapping systems allows tailored lesion sets in patients with atrial fibrillation (AF).

OBJECTIVE

We aimed to determine feasibility, safety, and 6-month outcome of F-PFA for a tailored substrate-based catheter ablation approach in patients with AF and advanced atrial substrate.

METHODS

Consecutive patients with AF and advanced atrial substrate treated by an F-PFA system (CardioFocus) through contact force-sensing catheters integrated in electroanatomic mapping systems were prospectively enrolled. The tailored substrate-based catheter ablation approach included isolation of all pulmonary veins with wide area circumferential ablation, posterior wall isolation, mitral anterior line, and cavotricuspid isthmus ablation, according to substrate. At 6 months, feasibility, arrhythmia recurrence, and safety were evaluated.

RESULTS

In 83 patients (33% female; indexed left atrial volume, 44 ± 15 mL/m2; 80% persistent AF or atrial flutter [AFl]; 57% redo procedures), successful de novo pulmonary vein isolation was performed in 36 patients and pulmonary vein reisolation in 30 patients. Mitral anterior line was performed in 19 patients with atypical AFl or anterior low-voltage areas; posterior wall isolation was performed in 38 patients with low-voltage areas or evoked delayed electrograms during premature atrial extrastimuli; and cavotricuspid isthmus ablation was performed in 24 patients with typical AFl. Median procedural and fluoroscopy times were 115 and 7 minutes, respectively. No complications occurred. At 6 months, arrhythmia recurred in 30 of 83 patients (21 AF; 9 atypical AFl).

CONCLUSION

Tailored substrate-based F-PFA in patients with AF and advanced atrial substrate is safe and effective. Acute procedural success was 100% with 64% freedom from arrhythmias after 6 months.