PULSED FIELD ABLATION FOR PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION USING AN OPTIMIZED BIPHASIC WAVEFORM: SINGLE CENTER OBSERVATIONAL STUDY

Background: Catether ablation of atrial fibrillation (AF) using thermal energies such as radiofreqency or cryothermy is associated with indiscriminate tissue destruction. Analysis conteined Farawave™ catheter PFA in single center high-volume center.
Objective: To evaluate a novel, focal PFA catheter in real clinical practise for catheter ablation paroxysmal and persistent AF.
Methods: Ablation was perfoermed using proprietary biphasic bipolar PFA waveform with in two diferent configurations: basket and flower for PV isolation (in 2+2 after rotating strategy) and flower for posterior wall ablation with 2 application per site. . In the case of posterior wall ablation we navigate the catheter by integration of CT and fluoroscopy system. Mitral and cavotricuspid isthmus line was performed if needed with 3 applications per each catheter position The index procedure was performed in deep sedation,intravenous atropin was administered prior PFA application.
Results: 846 patients (645 M/ 218 F), average age was 62,8 ±9,7 years; BMI 28,9± 4,4 underwent procedure for paroxysmal AF 493 pts, persistent AF 310 pts, long-standing persistent 55 pts and AT 5 pts. From the analysis we exclude 48 pts with concomitant electroanatomical mapping and additional RF lesions. All PVs were acutely isolated. Skin-to-skin procedure time and dose of radiation for paroxysmal AF was 42 ± 22 min (3,9 gym2); persistent AF 66±25 min (4,2 gym2); long-standing persistent AF 72±29 min (4,5 gym2) and AT 88±25 min (2,2 gym2). We have one pericardial tampoande and one significant stroke but there were no any other significant adverse event: including phrenic nerve and esophageal injury, PV stenosis.
Conclusion: PFA Farawave™ catheter proved very high effectivity allowing to facilitate ultra-rapid ablation procedure with excellent durability and safety.