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FEASIBILITY AND DURABILITY OF PULMONARY VEIN ISOLATION AND POSTERIOR LEFT ATRIAL WALL ABLATION USING NANOSECOND PULSE FIELD ABLATION: A FIRST-IN-HUMAN CLINICAL EXPERIENCE

P. Neužil, J. Petrů, M. Funasako, J. Škoda, P. Hála, M. Chovanec, B. Chudiak, M. Janotka, V. Lekešová (Praha)

Tématický okruh: Poruchy rytmu, kardiostimulace

Typ: Ústní sdělení - lékařské, XXXIII. Sjezd ČKS

Background: Beyond PVI to treat AF, perhaps the most common additional lesion set is ablation of the left atrial posterior wall (LAPW) – and increasingly so with the advent of PFA (given its safety with regard to the esophagus). While clinical PFA technologies all employ microsecond-scale pulses, nano-second PFA (nsPFA).
Objective: To assess the efficacy and durability of a combined lesion set of PVI + LAPW ablation using a nsPFA catheter.
Methods: An 11-Fr circular nsPFA catheter (CellFX nsPFA-360; Pulse Biosciences Inc) has a compliant framework to allow facile positioning in the LA and PVs. Between 2 circular electrodes (outer diameter ~30 mm), nsPFA is delivered to create a toroidal volumetric ablative field; 10 mini-electrodes allow electrical mapping. Under general anesthesia, with ICE guidance, using a 12Fr deflectable sheath, the catheter is used in concert with a 3D mapping system (Carto[JNJ MedTech], NavX[Abbott] or iMap[CardioNXT]) Invasive remapping was at 2-3 months.
Results: The 22-pt cohort (age 60.0±9.2 years; M/F 12/10; LA 4.2±0.5 cm; BMI 28.1±5.1) underwent acutely successful nsPFA, including 86 of 86 (100%) PVs and 22 of 22 (1005) LAPWs, requiring 12.0±2.1 and 4.6±1.8 nsPF applications for PVI and LAPW, respectively. The nsPFA catheter LA dwell time, total procedure time and fluoroscopy time were 26.2±13.7, 83.1±32.0 and 6.5±2.3 min, respectively. Invasive remapping revealed durable PVI in 81 of 86 PVs (94.2%) and LAPW in 21 of 22 (95.5%). There was 1 pericardial tamponade.
Conclusion: Using a compliant circular nanosecond PFA catheter, LA-PV anatomy was rendered, and both PVI and LAPW ablation were efficiently performed with good lesion durability on invasive remapping, setting the stage for future RCTs of the efficacy of LAPW ablation.