Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)

• Published in: Europace (London, England) Vol. 24; no. 8; pp. 1256 - 1266
• Main Authors: Ekanem, Emmanuel, Reddy, Vivek Y, Schmidt, Boris, Reichlin, Tobias, Neven, Kars, Metzner, Andreas, Hansen, Jim, Blaauw, Yuri, Maury, Philippe, Arentz, Thomas, Sommer, Philipp, Anic, Ante, Anselme, Frederic, Boveda, Serge, Deneke, Tom, Willems, Stephan, van der Voort, Pepijn, Tilz, Roland, Funasako, Moritoshi, Scherr, Daniel, Wakili, Reza, Steven, Daniel, Kautzner, Josef, Vijgen, Johan, Jais, Pierre, Petru, Jan, Chun, Julian, Roten, Laurent, Füting, Anna, Rillig, Andreas, Mulder, Bart A, Johannessen, Arne, Rollin, Anne, Lehrmann, Heiko, Sohns, Christian, Jurisic, Zrinka, Savoure, Arnaud, Combes, Stephanes, Nentwich, Karin, Gunawardene, Melanie, Ouss, Alexandre, Kirstein, Bettina, Manninger, Martin, Bohnen, Jan Eric, Sultan, Arian, Peichl, Petr, Koopman, Pieter, Derval, Nicolas, Turagam, Mohit K, Neuzil, Petr
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.09.2022
• Subjects: Adult; Aged; Aged, 80 and over; Atrial Fibrillation - diagnosis; Atrial Fibrillation - etiology; Atrial Fibrillation - surgery; Catheter Ablation - methods; Clinical Research; Female; Humans; Middle Aged; Pulmonary Veins - surgery; Retrospective Studies; Stroke - etiology; Treatment Outcome; Young Adult; Survey; Atrial fibrillation; Catheter ablation; Pulsed field ablation
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac050

Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement.