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Background <p>Pulsed field ablation (PFA) is a novel non-thermal energy source. Recently, we developed a tailored and streamlined pulmonary vein isolation (PVI) approach utilizing a pentaspline PFA catheter via a single access, single catheter approach. This study was aimed at comparing safety, efficacy, and follow-up of this approach with a conventional approach.</p> Methods and results <p>Fifty consecutive patients with atrial fibrillation (AF) underwent first-time PVI via PFA under deep sedation. The first 25 patients were treated with a conventional approach utilizing two femoral vein access sheath inclusive utilization of 3D mapping and a coronary sinus catheter (conventional approach, control group). The second 25 patients were treated via a simplified single venous, single transseptal puncture, single catheter approach utilizing a vascular closure system (Fast and Furious PFA approach, FAST group). A total of 194 PVs were identified and isolated with PFA only (100%). The median procedural time was 26 (25, 30) min (FAST) and 65 (59, 72) min (control), respectively (<i>P</i> &lt; 0.0001). The median fluoroscopy time was 5 (4, 7) min (FAST) and 12 (10, 14) min (control), respectively (<i>P</i> &lt; 0.001). Freedom from AF recurrence at 12 months was 77% for the FAST group (vs. control: 81%, <i>P</i> = 0.856, and overall: 79%).</p> Conclusion <p>The combination of a single venous puncture, single transseptal puncture approach utilizing PFA and vascular closure device resulted in a 100% rate of acute PVI and fast procedure with comparable safety, acute efficacy and 12-month outcome to the conventional approach.</p>

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Pulsed field ablation-based pulmonary vein isolation utilizing a simplified approach or a standard approach—insights from the fast and furious PFA study

  • 期刊论文

  • 发表日期：

    2025年4月21日

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  • Christian-H. Heeger,
  • Leonie Zetzsch,
  • Charlotte Eitel,
  • Jan-Per Wenzel,
  • Sorin Ștefan Popescu,
  • Henning Rolfes,
  • Sascha Hatahet,
  • Behnam Subin,
  • Karl-Heinz Kuck,
  • Roland R. Tilz

摘要

Background

Pulsed field ablation (PFA) is a novel non-thermal energy source. Recently, we developed a tailored and streamlined pulmonary vein isolation (PVI) approach utilizing a pentaspline PFA catheter via a single access, single catheter approach. This study was aimed at comparing safety, efficacy, and follow-up of this approach with a conventional approach.

Methods and results

Fifty consecutive patients with atrial fibrillation (AF) underwent first-time PVI via PFA under deep sedation. The first 25 patients were treated with a conventional approach utilizing two femoral vein access sheath inclusive utilization of 3D mapping and a coronary sinus catheter (conventional approach, control group). The second 25 patients were treated via a simplified single venous, single transseptal puncture, single catheter approach utilizing a vascular closure system (Fast and Furious PFA approach, FAST group). A total of 194 PVs were identified and isolated with PFA only (100%). The median procedural time was 26 (25, 30) min (FAST) and 65 (59, 72) min (control), respectively (P < 0.0001). The median fluoroscopy time was 5 (4, 7) min (FAST) and 12 (10, 14) min (control), respectively (P < 0.001). Freedom from AF recurrence at 12 months was 77% for the FAST group (vs. control: 81%, P = 0.856, and overall: 79%).

Conclusion

The combination of a single venous puncture, single transseptal puncture approach utilizing PFA and vascular closure device resulted in a 100% rate of acute PVI and fast procedure with comparable safety, acute efficacy and 12-month outcome to the conventional approach.