Impact of early recurrences on late recurrences after pulmonary vein isolation with pulse field ablation. A sub-analysis from the EU-PORIA multicentric international registry.

Stefano Bordignon (Frankfurt am Main)1, K. R. J. Chun (Frankfurt am Main)2, K. Neven (Essen)3, T. Reichlin (Bern)4, Y. Blaauw (Groningen)5, J. Hansen (Hellerup)6, R. Adelino (Toulouse)7, A. Ouss (Eindhoven)8, A. V. Füting (Essen)3, L. Roten (Bern)4, B. Mulder (Groningen)5, M. Ruwald (Hellerup)6, R. Mené (Toulouse)7, N. Reinsch (Essen)9, T. Kueffer (Bern)4, S. Boveda (Toulouse)7, B. Schmidt (Frankfurt am Main)10

1CCB am AGAPLESION BETHANIEN KRANKENHAUS Medizinisches Versorgungszentrum Frankfurt am Main, Deutschland; 2Agaplesion Markus Krankenhaus Medizinische Klinik III - CCB Frankfurt am Main, Deutschland; 3Alfried Krupp Krankenhaus Klinik für Kardiologie, Elektrophysiologie, Gastroenterologie & Intensivmedizin Essen, Deutschland; 4Inselspital - Universitätsspital Bern Bern, Schweiz; 5University of Groningen Department of Cardiology Groningen, Niederlande; 6Gentofte Hospital, Copenhagen, Arrhythmia Unit, Department of Cardiology Hellerup, Deutschland; 7Clinique Pasteur Heart Rhythm Department, Toulouse, Frankreich; 8Catharina Hospital Heart Center Eindhoven, Niederlande; 9Alfried Krupp Krankenhaus Klinik für Kardiologie, Elektrophysiologie, Nephrologie, Altersmedizin und Intensivmedizin Essen, Deutschland; 10Agaplesion Markus Krankenhaus Frankfurt am Main, Deutschland


Background: Early recurrences of atrial tachyarrhythmia (ERAT) are commonly observed after pulmonary vein isolation (PVI) with thermal energies. ERAT during the 90 days blanking period (BP) should not be considered as therapy failure, since late cure could be observed. Pulsed field ablation (PFA) is a myocardial-specific ablation technology for atrial fibrillation (AF). The different mechanism of myocardial injury of PFA may lead to a different meaning of ERAT following PVI.

Methods:  The EU-PORIA (EUropean real-world outcomes with Pulsed field ablatiOn in patients with symptomatic atRIAl fibrillation) is a multicentric international registry: data from 1233 patients treated with a pentaspline Farawave PFA Ablation system were collected. For the current analysis, patient with a previous AF ablation procedure, patients treated with lesions beyond PVI and patients without complete follow up data (during of following the BP) were excluded. The rate and meaning of ERAT following PFA PVI were analysed.

Results: 1011 patients (38% female, age 66±11, 64% paroxysmal atrial fibrillation [PAF]) were included in this analysis. ERATs were recorded in 178/1011 (18%) of patients (16% in PAF and 21% in persAF, p=0,021). Among other patient characteristics, ERAT patients were slightly older (67,1±11,4 Vs 65,4±10,9, p=0,015) and had a higher median CHADSVASC Score (2,5(IQR1-4) Vs 2(IQR1-3), p=0,019). The 35 mm catheter was more often used in ERAT patients (48/178(27%) Vs 148/833(18%) – p=0,005). During a median follow-up time of 365 days (IQR 347-390), 100/178(56%) of patients with ERAT also experienced a late recurrence (LR), significantly more compared to patient in SR during the BP (147/833(18%); p<0,001).  Kaplan Meier estimated overall freedom of AF/AT out of the BP was 77% at one year, with ERAT patients showing a lower estimated success rate compared to no ERAT (42% vs 84%, logrank p<0,001). ERAT were associated to long term success independently to the type of AF (41% Vs 88% in PAF, 43% vs 74% in persistent AF, both p<0,001). Among ERAT patients, no predictor for late LR could be identified.

Conclusions:  In this large multicentric international registry early recurrences of atrial tachyarrhythmia following PFA PVI were recorded in 18% of patients. ERATs were associated to late recurrences in the majority of cases, early identifying patients with a worse follow up. The need for a blanking period should be further questioned following non thermal energy ablation for atrial fibrillation.

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