Pulsed Field Ablation-Based Pulmonary Vein Isolation Using a Simplified Single-Access Single-Catheter Approach　― The Fast and Furious PFA Study

• Published in: Circulation Journal Vol. 87; no. 12; pp. 1722 - 1726
• Main Authors: Tilz, Roland R., Vogler, Julia, Kirstein, Bettina, Eitel, Charlotte, Phan, Huong-Lan, Popescu, Sorin Ștefan, Hatahet, Sascha, Große, Niels, Subin, Behnam, Lopez, Lisbeth Delgado, Kuck, Karl-Heinz, Heeger, Christian-H.
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.11.2023
• Subjects: Acute efficacy; Aged; Atrial fibrillation; Atrial Fibrillation - surgery; Catheter Ablation - methods; Catheters; Female; Humans; Male; Middle Aged; Pulmonary vein isolation; Pulmonary Veins - surgery; Pulse field ablation; Treatment Outcome; Venous closure system; Pulse field ablation; Venous closure system; Atrial fibrillation; Acute efficacy; Pulmonary vein isolation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-23-0389

Background: Pulsed field ablation (PFA) is a non-thermal energy source with promising safety and efficacy advantages. We aimed to develop a convenient, safe, effective and fast method of pulmonary vein isolation (PVI) utilizing a penta-spline PFA catheter via a single femoral vein and a venous closure system.Methods and Results: Consecutive patients (n=50; mean age: 63.6±10.7 years, 38% female) presenting with AF (paroxysmal AF: 56%) underwent first-time PVI via PFA. A single ultrasound-guided femoral vein puncture and a single transseptal puncture were used. After PVI using the penta-spline PFA catheter, extra pulse trains were added to the posterior wall for wide antral circumferential ablation. A venous closure system was used and a Donati suture was performed. The pressure bandage was removed after 1 h. A total of 196 PVs were identified and isolated with PFA only. The mean procedural time was 27.4±6.6 min, and the mean dwelling time was 14.4±5.5 min. Time to ambulation was 3.3±3.1 h. No severe complications occurred. During a mean follow-up of 6.5±2.1 months, 41/50 patients (82%) remained in sinus rhythm.Conclusions: The combination of a single venous puncture, single transseptal puncture approach using PFA and vascular closure device resulted in a 100% rate of acute PVI and an extraordinarily fast procedure and time to ambulation. The rate of periprocedural complications was low.