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2020 AF Symposium Abstract

Pulsed Field Ablation Follow-Up Study

Dr. Vivek Reddy, Mt Siani Hospital

Dr Vivek Reddy, Mt Sinai Hospital

Background: At the 2020 AF Symposium, Dr. Vivek Reddy demonstrated an ablation using Pulsed Field Ablation (PFA). Radically improving ablation treatment, PFA is:
• Tissue selective; affects heart tissue only and not other structures or organs.
• Very fast and precise; long-lasting lesions can be delivered in seconds.
• No direct contact needed only proximity, i.e., millimeters from the targeted tissue.
• Safer than current ablation energy sources, primarily because of its tissue selectivity.
• Offers two catheter shapes designed to fit into various areas of the heart.

But Does Pulsed Field Ablation Endure Long-Term?

The durability of PFA lesions is the focus of Dr. Vivek Reddy’s abstract, Lesion Durability and Safety Outcomes of Pulsed Field Ablation. His research study followed 113 patients who each received a PFA ablation.

Study Description: Patients were enrolled in 3 multi-center clinical trials which used a biphasic PFA waveform with a basket/flower catheter configuration.

Dwell time’ is the time transpiring from introduction of the ablation catheter into the body to the catheter’s removal.

Five EPs were chosen to do the PFA ablations. The 88 most recent patients were ablated. They were not under general anesthesia. PFA procedures required around 33 minutes of Left Atrium (LA) dwell time.

Follow-up Testing and Results: At 75-90 days, patients were invasively re-mapped.

Then, after 1 year, the Pulmonary Vein (PV) lesions were re-assessed and safety re-examined.

All PVs remained isolated. The primary safety event rate was 1.8% (1 pericardial tamponade, 1 groin hematoma).

The esophagus was carefully evaluated. There was no evidence of thermal esophageal lesions.

Cerebral MRI revealed no post-procedure swelling (ischemia). There was no PV stenosis. There were no latent safety issues. Invasive re-map procedures showed that lesion durability of the Pulmonary Veins reached 98%.

Study Conclusion

The researchers concluded that Pulsed Field Ablation (PFA) demonstrated:

• An excellent safety profile, no unexpected safety issues over a full year of follow-up.
• A very high rate of long-term Pulmonary Vein isolation (durable lesions).

So Does Pulsed Field Ablation Endure Long-Term? Yes!

Editor’s Comments

A year’s follow-up demonstrated that Pulsed Field Ablation (PFA) is a significant improvement over current ablation treatments. And these extraordinary results were obtained by 5 operators, which means that PFA is not dependent of the skill of a particular electrophysiologist.
I predict that Pulsed Field Ablation (PFA) will supersede all current ablation strategies. It’s almost too good to be true.

Unfortunately, it will probably take 3-5 years for PFA to be available for most A-Fib patients.

References for this report
Reddy, V. et al. Lesion Durability and Safety Outcomes of Pulsed Field Ablation in > 100 Paroxysmal Atrial Fibrillation Patients. AF Symposium 2020 brochure, Abstract AFS2020-19, p. 44. Ichan School of Medicine at Mount Sinai.

If you find any errors on this page, email us. Y Last updated: Saturday, May 2, 2020

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