Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation

Mohit K. Turagam; Petr Neuzil; Boris Schmidt; Tobias Reichlin; Kars Neven; Andreas Metzner; Jim Hansen; Yuri Blaauw; Philippe Maury; Thomas Arentz; Philipp Sommer; Ante Anic; Frederic Anselme; Serge Boveda; Tom Deneke; Stephan Willems; Pepijn van der Voort; Roland Tilz; Moritoshi Funasako; Daniel Scherr; Reza Wakili; Daniel Steven; Josef Kautzner; Johan Vijgen; Pierre Jais; Jan Petru; Julian Chun; Laurent Roten; Anna Füting; Marc D. Lemoine; Martin Ruwald; Bart A. Mulder; Anne Rollin; Heiko Lehrmann; Thomas Fink; Zrinka Jurisic; Corentin Chaumont; Raquel Adelino; Karin Nentwich; Melanie Gunawardene; Alexandre Ouss; Christian Hendrik Heeger; Martin Manninger; Jan Eric Bohnen; Arian Sultan; Petr Peichl; Pieter Koopman; Nicolas Derval; Thomas Kueffer; Nico Reinsch

doi:10.1016/j.jacep.2024.01.017

Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation

Mohit K. Turagam, Petr Neuzil, Boris Schmidt, Tobias Reichlin, Kars Neven, Andreas Metzner, Jim Hansen, Yuri Blaauw, Philippe Maury, Thomas Arentz, Philipp Sommer, Ante Anic, Frederic Anselme, Serge Boveda, Tom Deneke, Stephan Willems, Pepijn van der Voort, Roland Tilz, Moritoshi Funasako, Daniel ScherrReza Wakili, Daniel Steven, Josef Kautzner, Johan Vijgen, Pierre Jais, Jan Petru, Julian Chun, Laurent Roten, Anna Füting, Marc D. Lemoine, Martin Ruwald, Bart A. Mulder, Anne Rollin, Heiko Lehrmann, Thomas Fink, Zrinka Jurisic, Corentin Chaumont, Raquel Adelino, Karin Nentwich, Melanie Gunawardene, Alexandre Ouss, Christian Hendrik Heeger, Martin Manninger, Jan Eric Bohnen, Arian Sultan, Petr Peichl, Pieter Koopman, Nicolas Derval, Thomas Kueffer, Nico Reinsch

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

14 Citations (Scopus)

67 Downloads (Pure)

Abstract

Background: Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. Objectives: This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). Methods: In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. Results: Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA₂DS₂-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). Conclusions: In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.

Original language	English
Pages (from-to)	900-912
Number of pages	13
Journal	JACC: Clinical Electrophysiology
Volume	10
Issue number	5
DOIs	https://doi.org/10.1016/j.jacep.2024.01.017
Publication status	Published - May-2024

Keywords

atrial fibrillation
posterior wall ablation
pulmonary vein isolation
pulsed field ablation

Access to Document

10.1016/j.jacep.2024.01.017

Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial FibrillationFinal publisher's version, 1.21 MBLicence: Taverne

Handle.net

Persistent link

Cite this

Turagam, M. K., Neuzil, P., Schmidt, B., Reichlin, T., Neven, K., Metzner, A., Hansen, J., Blaauw, Y., Maury, P., Arentz, T., Sommer, P., Anic, A., Anselme, F., Boveda, S., Deneke, T., Willems, S., van der Voort, P., Tilz, R., Funasako, M., ... Reinsch, N. (2024). Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation. JACC: Clinical Electrophysiology, 10(5), 900-912. https://doi.org/10.1016/j.jacep.2024.01.017

@article{d6f2ef1641dc484089936b5e3264e6a2,

title = "Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation",

abstract = "Background: Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. Objectives: This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). Methods: In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. Results: Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). Conclusions: In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.",

keywords = "atrial fibrillation, posterior wall ablation, pulmonary vein isolation, pulsed field ablation",

author = "Turagam, {Mohit K.} and Petr Neuzil and Boris Schmidt and Tobias Reichlin and Kars Neven and Andreas Metzner and Jim Hansen and Yuri Blaauw and Philippe Maury and Thomas Arentz and Philipp Sommer and Ante Anic and Frederic Anselme and Serge Boveda and Tom Deneke and Stephan Willems and {van der Voort}, Pepijn and Roland Tilz and Moritoshi Funasako and Daniel Scherr and Reza Wakili and Daniel Steven and Josef Kautzner and Johan Vijgen and Pierre Jais and Jan Petru and Julian Chun and Laurent Roten and Anna F{\"u}ting and Lemoine, {Marc D.} and Martin Ruwald and Mulder, {Bart A.} and Anne Rollin and Heiko Lehrmann and Thomas Fink and Zrinka Jurisic and Corentin Chaumont and Raquel Adelino and Karin Nentwich and Melanie Gunawardene and Alexandre Ouss and Heeger, {Christian Hendrik} and Martin Manninger and Bohnen, {Jan Eric} and Arian Sultan and Petr Peichl and Pieter Koopman and Nicolas Derval and Thomas Kueffer and Nico Reinsch",

note = "Publisher Copyright: {\textcopyright} 2024 American College of Cardiology Foundation",

year = "2024",

month = may,

doi = "10.1016/j.jacep.2024.01.017",

language = "English",

volume = "10",

pages = "900--912",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier",

number = "5",

}

Turagam, MK, Neuzil, P, Schmidt, B, Reichlin, T, Neven, K, Metzner, A, Hansen, J, Blaauw, Y, Maury, P, Arentz, T, Sommer, P, Anic, A, Anselme, F, Boveda, S, Deneke, T, Willems, S, van der Voort, P, Tilz, R, Funasako, M, Scherr, D, Wakili, R, Steven, D, Kautzner, J, Vijgen, J, Jais, P, Petru, J, Chun, J, Roten, L, Füting, A, Lemoine, MD, Ruwald, M, Mulder, BA, Rollin, A, Lehrmann, H, Fink, T, Jurisic, Z, Chaumont, C, Adelino, R, Nentwich, K, Gunawardene, M, Ouss, A, Heeger, CH, Manninger, M, Bohnen, JE, Sultan, A, Peichl, P, Koopman, P, Derval, N, Kueffer, T & Reinsch, N 2024, 'Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation', JACC: Clinical Electrophysiology, vol. 10, no. 5, pp. 900-912. https://doi.org/10.1016/j.jacep.2024.01.017

TY - JOUR

T1 - Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation

AU - Turagam, Mohit K.

AU - Neuzil, Petr

AU - Schmidt, Boris

AU - Reichlin, Tobias

AU - Neven, Kars

AU - Metzner, Andreas

AU - Hansen, Jim

AU - Blaauw, Yuri

AU - Maury, Philippe

AU - Arentz, Thomas

AU - Sommer, Philipp

AU - Anic, Ante

AU - Anselme, Frederic

AU - Boveda, Serge

AU - Deneke, Tom

AU - Willems, Stephan

AU - van der Voort, Pepijn

AU - Tilz, Roland

AU - Funasako, Moritoshi

AU - Scherr, Daniel

AU - Wakili, Reza

AU - Steven, Daniel

AU - Kautzner, Josef

AU - Vijgen, Johan

AU - Jais, Pierre

AU - Petru, Jan

AU - Chun, Julian

AU - Roten, Laurent

AU - Füting, Anna

AU - Lemoine, Marc D.

AU - Ruwald, Martin

AU - Mulder, Bart A.

AU - Rollin, Anne

AU - Lehrmann, Heiko

AU - Fink, Thomas

AU - Jurisic, Zrinka

AU - Chaumont, Corentin

AU - Adelino, Raquel

AU - Nentwich, Karin

AU - Gunawardene, Melanie

AU - Ouss, Alexandre

AU - Heeger, Christian Hendrik

AU - Manninger, Martin

AU - Bohnen, Jan Eric

AU - Sultan, Arian

AU - Peichl, Petr

AU - Koopman, Pieter

AU - Derval, Nicolas

AU - Kueffer, Thomas

AU - Reinsch, Nico

PY - 2024/5

Y1 - 2024/5

N2 - Background: Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. Objectives: This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). Methods: In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. Results: Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). Conclusions: In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.

AB - Background: Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. Objectives: This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). Methods: In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. Results: Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). Conclusions: In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.

KW - atrial fibrillation

KW - posterior wall ablation

KW - pulmonary vein isolation

KW - pulsed field ablation

UR - http://www.scopus.com/inward/record.url?scp=85188205503&partnerID=8YFLogxK

U2 - 10.1016/j.jacep.2024.01.017

DO - 10.1016/j.jacep.2024.01.017

M3 - Article

C2 - 38430087

AN - SCOPUS:85188205503

SN - 2405-500X

VL - 10

SP - 900

EP - 912

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 5

ER -

Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation

Abstract

Keywords

Access to Document

Handle.net

Other files and links

Fingerprint

Cite this