PULSED FIELD ABLATION IN OVER 2 K PATIENTS FOR PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION IN SINGLE CENTER.

Background:  Pulsed field ablation (PFA) with adapted sub-second electric – fields create pores in cell membranes – caused irreversible electroporation. Analysis conteined Farawave™ catheter PFA in single center high-volume center.
Methods: Ablation was performed using proprietary biphasic bipolar PFA waveform with in two diferent configurations: basket and flower for PV isolation (in 2+2 after rotating strategy), flower for left atrium posterior wall, mitral isthmus and cavo-tricuspid isthmus ablation. In the case of posterior wall ablation Farawave™ catheter was navigated by integration with CT and fluoroscopy system. The index procedure was performed in deep sedation,intravenous atropin was administered prior PFA application.
Results: 2.152 patients (1354 M/ 798 F), average age was 66,7 ±11,3 years; BMI 28,9± 7,9 underwent procedure for paroxysmal AF (1123 ), for persistent AF (853 ), long-standing persistent AF (168) and atrial tachycardia (8). Mean LV EF was 58,2±9,5%. All PVs were acutely isolated with PFA ≤ 3,2 min elapsed delivery/patient, skin-to-skin procedure time for paroxysmal AF was 34,8 ± 8,9 min and fluoroscopy time of 4,96 ± 6,59 min. For persistent and long-standing persistent AF skin-to-skin procedure time was 59,7 ± 17,8 68,8 ± 21,8 min respectively and fluoroscopy time was 6,4±5,23 min and 6,82 ± 4,4 min. For AT the total procedure time was 72,4±23,5 min. and fluoroscopy 7,2 ± 4,8 min. PVI was done in 2.131 pts, posterior LA isolation in 1.371 pts, mitral isthmus PFA in 431 and CTI in 650 pts. During mean time follow-up time of 487 days the freedom from arrhythmia was 88.1 ± 4,8 % on Holters and ECGs for all types of atrial arrhythmias.
Conclusion: In these over 2.000 patients underwent PFA as a real clinical practise for all types of AF and ATs, with excellent durability and safety.