Focal Pulsed Field Ablation in Patients with Atrial Fibrillation and Atypical Flutter as „trouble shooter“

Patricia Hägele (Aalen)1, V. Adam (Aalen)2, P. Biehler (Aalen)1, S. Hanger (Aalen)1, A. Pinchuk (Aalen)1, C. Wächter (Marburg)3, S. Weyand (Aalen)1, P. Seizer (Aalen)1

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.

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