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Article Abstract
Background: Pulsed field ablation (PFA) is a novel non-thermal energy source. Recently, we developed a tailored and streamlined pulmonary vein isolation (PVI) approach utilizing a pentaspline PFA catheter via a single access, single catheter approach. This study was aimed at comparing safety, efficacy, and follow-up of this approach with a conventional approach.
Methods And Results: Fifty consecutive patients with atrial fibrillation (AF) underwent first-time PVI via PFA under deep sedation. The first 25 patients were treated with a conventional approach utilizing two femoral vein access sheath inclusive utilization of 3D mapping and a coronary sinus catheter (conventional approach, control group). The second 25 patients were treated via a simplified single venous, single transseptal puncture, single catheter approach utilizing a vascular closure system (Fast and Furious PFA approach, FAST group). A total of 194 PVs were identified and isolated with PFA only (100%). The median procedural time was 26 (25, 30) min (FAST) and 65 (59, 72) min (control), respectively (P < 0.0001). The median fluoroscopy time was 5 (4, 7) min (FAST) and 12 (10, 14) min (control), respectively (P < 0.001). Freedom from AF recurrence at 12 months was 77% for the FAST group (vs.
Control: 81%, P = 0.856, and overall: 79%).
Conclusion: The combination of a single venous puncture, single transseptal puncture approach utilizing PFA and vascular closure device resulted in a 100% rate of acute PVI and fast procedure with comparable safety, acute efficacy and 12-month outcome to the conventional approach.
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