Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effect
BackgroundWide antral circumferential ablation (WACA) in comparison to ostial pulmonary vein (PV) isolation (PVI) has been attributed with improved rhythm outcome. We investigated the feasibility, lesion formation, and rhythm outcome of WACA-PVI in comparison to ostial-PVI using pulsed field ablatio...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1217745/full |
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| author | Roland R. Tilz Roland R. Tilz Christian H. Heeger Christian H. Heeger Julia Vogler Charlotte Eitel Marcel Feher Huong-Lan Phan Ilias Mushfiq Sorin S. Popescu Leonie Zetzsch Anna Traub Sascha Hatahet Kai Mortensen Karl-Heinz Kuck Bettina Kirstein |
| author_facet | Roland R. Tilz Roland R. Tilz Christian H. Heeger Christian H. Heeger Julia Vogler Charlotte Eitel Marcel Feher Huong-Lan Phan Ilias Mushfiq Sorin S. Popescu Leonie Zetzsch Anna Traub Sascha Hatahet Kai Mortensen Karl-Heinz Kuck Bettina Kirstein |
| author_sort | Roland R. Tilz |
| collection | DOAJ |
| description | BackgroundWide antral circumferential ablation (WACA) in comparison to ostial pulmonary vein (PV) isolation (PVI) has been attributed with improved rhythm outcome. We investigated the feasibility, lesion formation, and rhythm outcome of WACA-PVI in comparison to ostial-PVI using pulsed field ablation (PFA).MethodsSymptomatic atrial fibrillation (AF) patients (69 years, 67% male; 67% paroxysmal AF) were prospectively enrolled into our single-center registry and underwent first-time ostial-PFA or WACA-PFA, N = 15 each. In all patients, eight pulse trains (2 kV/2.5 s, bipolar, biphasic, 4× basket/flower configuration each) were delivered to each PV. In WACA-PFA, two extra pulse trains in a flower configuration were added to the anterior and posterior antrum of the PVs. For comparison of PFA lesion size, pre- and post-ablation left atrial (LA) voltage maps were acquired using a multipolar spiral catheter together with a three-dimensional electroanatomic mapping system.ResultsWACA-PFA resulted in a significant larger lesion formation than ostial-PFA (45.5 vs. 35.1 cm2, p = 0.001) with bilateral overlapping butterfly shape-like lesions and concomitant posterior LA wall isolation in 73% of patients. This was not associated with increased procedure time, sedation dosage, or exposure to radiation. One-year freedom from AF recurrence was numerically higher after WACA-PFA than ostial-PFA (94% vs. 87%) but not statistically significant (p = 0.68). No organized atrial tachycardias (ATs) were observed. Ostial-PFA patients more often underwent re-ablation due to recurrent AF episodes.ConclusionWACA-PFA is feasible and resulted in significantly wider lesion sets than ostial-PFA. Concomitant posterior LA wall isolation occurred as an epiphenomenon in the majority of patients. The WACA approach was associated with neither increased procedure and fluoroscopy times nor statistically significant differences in 1-year rhythm outcome. ATs were absent. |
| first_indexed | 2024-03-13T03:12:44Z |
| format | Article |
| id | doaj.art-336614579eff41d787ff065c5f6e8c6c |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-13T03:12:44Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-336614579eff41d787ff065c5f6e8c6c2023-06-26T10:37:15ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-06-011010.3389/fcvm.2023.12177451217745Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effectRoland R. Tilz0Roland R. Tilz1Christian H. Heeger2Christian H. Heeger3Julia Vogler4Charlotte Eitel5Marcel Feher6Huong-Lan Phan7Ilias Mushfiq8Sorin S. Popescu9Leonie Zetzsch10Anna Traub11Sascha Hatahet12Kai Mortensen13Karl-Heinz Kuck14Bettina Kirstein15Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyGerman Center for Cardiovascular Research (DZHK), Partner Site, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyDepartment of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyBackgroundWide antral circumferential ablation (WACA) in comparison to ostial pulmonary vein (PV) isolation (PVI) has been attributed with improved rhythm outcome. We investigated the feasibility, lesion formation, and rhythm outcome of WACA-PVI in comparison to ostial-PVI using pulsed field ablation (PFA).MethodsSymptomatic atrial fibrillation (AF) patients (69 years, 67% male; 67% paroxysmal AF) were prospectively enrolled into our single-center registry and underwent first-time ostial-PFA or WACA-PFA, N = 15 each. In all patients, eight pulse trains (2 kV/2.5 s, bipolar, biphasic, 4× basket/flower configuration each) were delivered to each PV. In WACA-PFA, two extra pulse trains in a flower configuration were added to the anterior and posterior antrum of the PVs. For comparison of PFA lesion size, pre- and post-ablation left atrial (LA) voltage maps were acquired using a multipolar spiral catheter together with a three-dimensional electroanatomic mapping system.ResultsWACA-PFA resulted in a significant larger lesion formation than ostial-PFA (45.5 vs. 35.1 cm2, p = 0.001) with bilateral overlapping butterfly shape-like lesions and concomitant posterior LA wall isolation in 73% of patients. This was not associated with increased procedure time, sedation dosage, or exposure to radiation. One-year freedom from AF recurrence was numerically higher after WACA-PFA than ostial-PFA (94% vs. 87%) but not statistically significant (p = 0.68). No organized atrial tachycardias (ATs) were observed. Ostial-PFA patients more often underwent re-ablation due to recurrent AF episodes.ConclusionWACA-PFA is feasible and resulted in significantly wider lesion sets than ostial-PFA. Concomitant posterior LA wall isolation occurred as an epiphenomenon in the majority of patients. The WACA approach was associated with neither increased procedure and fluoroscopy times nor statistically significant differences in 1-year rhythm outcome. ATs were absent.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1217745/fullpulmonary vein ablation/isolationWACApulsed field ablationatrial fibrillationcatheter ablation |
| spellingShingle | Roland R. Tilz Roland R. Tilz Christian H. Heeger Christian H. Heeger Julia Vogler Charlotte Eitel Marcel Feher Huong-Lan Phan Ilias Mushfiq Sorin S. Popescu Leonie Zetzsch Anna Traub Sascha Hatahet Kai Mortensen Karl-Heinz Kuck Bettina Kirstein Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effect Frontiers in Cardiovascular Medicine pulmonary vein ablation/isolation WACA pulsed field ablation atrial fibrillation catheter ablation |
| title | Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effect |
| title_full | Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effect |
| title_fullStr | Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effect |
| title_full_unstemmed | Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effect |
| title_short | Wide antral circumferential vs. ostial pulmonary vein isolation using pulsed field ablation—the butterfly effect |
| title_sort | wide antral circumferential vs ostial pulmonary vein isolation using pulsed field ablation the butterfly effect |
| topic | pulmonary vein ablation/isolation WACA pulsed field ablation atrial fibrillation catheter ablation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1217745/full |
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