1Ostalb-Klinikum Aalen Innere Medizin II, Kardiologie und Angiologie Aalen, Deutschland; 2Ostalb-Klinikum Aalen Pädiatrie Aalen, Deutschland; 3Universitätsklinikum Giessen und Marburg GmbH Klinik für Innere Medizin - Schwerpunkt Kardiologie Marburg, Deutschland
Background: Focal pulsed field ablation (PFA) (Galaxy Medical, San Carlos, CA) is a new technique in cardiac electrophysiology. Due to its excellent efficacy and safety properties we used it as “trouble shooter” in complex re-do procedures after 1 or more procedures with pulmonary vein isolation.
Methods: Between January and October 2023 40 patients with recurrence of atrial fibrillation or atypical flutter after 1-2 former PVIs were treated with focal pulsed field ablation using the CENTRAURI system. Two different mapping systems were used (Ensite X and Carto 3). The procedure followed a fixed protocol including re-isolation of the pulmonary veins as well as substrate-based additional lines like an anterior mitral line and/or a posterior box. The endpoint of the ablation was stable sinus rhythm and no inducibility of the respective tachycardia. Adenosin was administered in every patient as test for dormant recconection.
Results: In comparison to radiofrequency-ablation patients were comparable in age, BMI and CHA2DS2-VASc-score. A stable sinusrhythm was achieved in all patients. The mean duration time of the PFA-procedure was 132 (+/- 41) minutes. In 30 patients (75%) pulmonary veins were re-isolated. At the end of the procedure all additional lines were blocked (100% success rate). In summary there were 24 cases with posterior box isolation, 25 procedures with additional anterior or lateral mitral line and 15 roof line as well as 8 cases of additional cavotricuspidal isthmus ablation.
Conclusions: Acute procedural success of focal PFA using the CENTAURI System shows high efficacy in complex redo procedures in patients with atrial arrhythmia.