Impact of adjunctive posterior left atrial ablation using pulsed field ablation on health care utilization in patients receiving first-time catheter ablation for atrial fibrillation: Results from the multicenter SENTINEL registry.
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Sindone James, Brienesse Stephen, Virk Sohaib, Ng Austin Chin Chwan, Ha Francis, Kwan Timothy, Puvrez Alexis, Kistler Bruno Scardamaglia, Zhou Julia, Li Joan, Ferreira David, Witting Timothy, Bhat Vikas, Mackin Gareth, Govender Kerissa, Kilborn Michael J, Thomas Stuart P, Chik William, McGuire Mark A, Wilsmore Bradley, Healy Stewart, Chan Kim H, Neven Kars, Samie Rafeeq, O'Connor Matthew, Stiles Martin K, Singarayar Suresh, Qian Pierre, Jackson Nicholas, Kotschet Emily, Sanders Prashanthan, Kistler Peter M, Sy Raymond W, SENTINEL Registry Investigators
Аннотация
OBJECTIVES: The study compares the efficacy and safety of pulmonary vein isolation (PVI)+PLAA with PVI alone using PFA.
METHODS: This study presents a retrospective analysis in patients who underwent first-time ablation with Farapulse PFA system using data collected in the Australia and New Zealand Pentaspline PFA registry. Primary outcome was health care utilization (composite of unplanned rehospitalization for atrial arrhythmias, cardioversion, and/or repeat ablation).
RESULTS: Of the 1611 patients who underwent ablation, adjunctive PLAA was performed in 30%. Patients receiving PVI+PLAA were older than those receiving PVI alone, with higher CHA2DS2-VA score, and more likely to have non-paroxysmal atrial fibrillation (74% vs 27%), left atrial (LA) dilatation, and reduced left ventricular ejection fraction (P < .01 for all comparisons). There was no significant difference in 30-day adverse events (0.8% vs 0.5%, P = .50). After adjustment for baseline differences, health care utilization was reduced in patients who underwent PVI+PLAA, with an adjusted hazard ratio of 0.52 (95% confidence interval, 0.31‒0.89; P = .016) during median follow-up of 426 days. The adjusted risks of unplanned rehospitalization, cardioversion, and clinical arrhythmia recurrence were all significantly lower for PVI+PLAA (P < .05). After propensity score matching, PVI+PLAA was also associated with lower risk of health care utilization (hazard ratio, 0.57; 95% confidence interval, 0.34-0.96; P = .03).
CONCLUSION: In this large multicenter comparative analysis of adjunctive PLAA+PVI vs PVI alone using PFA, adjunctive PLAA ablation was safe and was associated with lower health care utilization in patients receiving first-time catheter ablation for atrial fibrillation.