Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry

Thomas Kueffer; Stefano Bordignon; Kars Neven; Yuri Blaauw; Jim Hansen; Raquel Adelino; Alexandre Ouss; Anna Füting; Laurent Roten; Bart A Mulder; Martin H Ruwald; Roberto Mené; Pepijn van der Voort; Nico Reinsch; Serge Boveda; Elizabeth M Albrecht; Christopher W Schneider; K R Julian Chun; Boris Schmidt; Tobias Reichlin

doi:10.1016/j.jacep.2023.11.026

Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry

Thomas Kueffer, Stefano Bordignon, Kars Neven, Yuri Blaauw, Jim Hansen, Raquel Adelino, Alexandre Ouss, Anna Füting, Laurent Roten, Bart A Mulder, Martin H Ruwald, Roberto Mené, Pepijn van der Voort, Nico Reinsch, Serge Boveda, Elizabeth M Albrecht, Christopher W Schneider, K R Julian Chun, Boris Schmidt, Tobias Reichlin^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce.

OBJECTIVES: This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA.

METHODS: Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified.

RESULTS: Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50).

CONCLUSIONS: In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.

Original language	English
Pages (from-to)	698-708
Number of pages	11
Journal	JACC: Clinical Electrophysiology
Volume	10
Issue number	4
DOIs	https://doi.org/10.1016/j.jacep.2023.11.026
Publication status	Published - Apr-2024

Keywords

Humans
Pulmonary Veins/surgery
Atrial Fibrillation/surgery
Male
Female
Middle Aged
Registries
Catheter Ablation/methods
Aged
Europe
Treatment Outcome
Recurrence
Reoperation/statistics & numerical data

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Kueffer, T., Bordignon, S., Neven, K., Blaauw, Y., Hansen, J., Adelino, R., Ouss, A., Füting, A., Roten, L., Mulder, B. A., Ruwald, M. H., Mené, R., van der Voort, P., Reinsch, N., Boveda, S., Albrecht, E. M., Schneider, C. W., Chun, K. R. J., Schmidt, B., & Reichlin, T. (2024). Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry. JACC: Clinical Electrophysiology, 10(4), 698-708. https://doi.org/10.1016/j.jacep.2023.11.026

@article{639dbeb3f3b74eec88b4263a3d8ec706,

title = "Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry",

abstract = "BACKGROUND: Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce.OBJECTIVES: This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA.METHODS: Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified.RESULTS: Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50).CONCLUSIONS: In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.",

keywords = "Humans, Pulmonary Veins/surgery, Atrial Fibrillation/surgery, Male, Female, Middle Aged, Registries, Catheter Ablation/methods, Aged, Europe, Treatment Outcome, Recurrence, Reoperation/statistics & numerical data",

author = "Thomas Kueffer and Stefano Bordignon and Kars Neven and Yuri Blaauw and Jim Hansen and Raquel Adelino and Alexandre Ouss and Anna F{\"u}ting and Laurent Roten and Mulder, {Bart A} and Ruwald, {Martin H} and Roberto Men{\'e} and {van der Voort}, Pepijn and Nico Reinsch and Serge Boveda and Albrecht, {Elizabeth M} and Schneider, {Christopher W} and Chun, {K R Julian} and Boris Schmidt and Tobias Reichlin",

year = "2024",

month = apr,

doi = "10.1016/j.jacep.2023.11.026",

language = "English",

volume = "10",

pages = "698--708",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier",

number = "4",

}

Kueffer, T, Bordignon, S, Neven, K, Blaauw, Y, Hansen, J, Adelino, R, Ouss, A, Füting, A, Roten, L, Mulder, BA, Ruwald, MH, Mené, R, van der Voort, P, Reinsch, N, Boveda, S, Albrecht, EM, Schneider, CW, Chun, KRJ, Schmidt, B & Reichlin, T 2024, 'Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry', JACC: Clinical Electrophysiology, vol. 10, no. 4, pp. 698-708. https://doi.org/10.1016/j.jacep.2023.11.026

TY - JOUR

T1 - Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation

T2 - Results From the Multicenter EU-PORIA Registry

AU - Kueffer, Thomas

AU - Bordignon, Stefano

AU - Neven, Kars

AU - Blaauw, Yuri

AU - Hansen, Jim

AU - Adelino, Raquel

AU - Ouss, Alexandre

AU - Füting, Anna

AU - Roten, Laurent

AU - Mulder, Bart A

AU - Ruwald, Martin H

AU - Mené, Roberto

AU - van der Voort, Pepijn

AU - Reinsch, Nico

AU - Boveda, Serge

AU - Albrecht, Elizabeth M

AU - Schneider, Christopher W

AU - Chun, K R Julian

AU - Schmidt, Boris

AU - Reichlin, Tobias

PY - 2024/4

Y1 - 2024/4

N2 - BACKGROUND: Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce.OBJECTIVES: This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA.METHODS: Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified.RESULTS: Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50).CONCLUSIONS: In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.

AB - BACKGROUND: Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce.OBJECTIVES: This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA.METHODS: Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified.RESULTS: Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50).CONCLUSIONS: In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.

KW - Humans

KW - Pulmonary Veins/surgery

KW - Atrial Fibrillation/surgery

KW - Male

KW - Female

KW - Middle Aged

KW - Registries

KW - Catheter Ablation/methods

KW - Aged

KW - Europe

KW - Treatment Outcome

KW - Recurrence

KW - Reoperation/statistics & numerical data

U2 - 10.1016/j.jacep.2023.11.026

DO - 10.1016/j.jacep.2023.11.026

M3 - Article

C2 - 38340118

SN - 2405-500X

VL - 10

SP - 698

EP - 708

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 4

ER -

Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry

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