TY - JOUR
T1 - Pulsed Field Ablation as First-line Therapy for Atrial Fibrillation
T2 - A Substudy of the EU-PORIA Registry
AU - Füting, Anna
AU - Neven, Kars
AU - Bordignon, Stefano
AU - Reichlin, Tobias
AU - Blaauw, Yuri
AU - Hansen, Jim
AU - Adelino, Raquel
AU - Ouss, Alexandre
AU - Roten, Laurent
AU - Mulder, Bart A
AU - Ruwald, Martin H
AU - Mené, Roberto
AU - van der Voort, Pepijn
AU - Reinsch, Nico
AU - Kueffer, Thomas
AU - Boveda, Serge
AU - Albrecht, Elizabeth M
AU - Raybuck, Jonathan D
AU - Sutton, Brad
AU - Chun, Kyoung Ryul Julian
AU - Schmidt, Boris
PY - 2024/11/27
Y1 - 2024/11/27
N2 - BACKGROUND: Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy. Examination of real-world data may shed light on clinical practices and the effectiveness of PFA with and without a prior history of AAD usage.METHODS: EU-PORIA is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at 7 high-volume centers in Europe. This subanalysis evaluates patients with a history of class I/III AAD use versus those with no documented history of class I/III AAD use (first-line patients). Patients with incomplete AAD history, long-standing persistent AF, and those undergoing a repeat ablation procedure were excluded. Patients were treated and followed based on institutional standard of care. Any episode of atrial tachycardia or AF lasting longer than 30 s was considered an arrhythmia recurrence.RESULTS: Of 1233 patients enrolled in EU-PORIA, 1091 met the inclusion criteria (mean age, 66 years; 40% females; and persistent AF, 36%). Pulmonary vein isolation-only was used in 90% of the patients, and 10% received extra-PV ablation. Ablation as the first-line approach was chosen in 589 patients, and 502 patients had prior class I/III AAD use. In the first-line PFA group, paroxysmal AF was more frequent (68% versus 59%;
P<0.001), and pulmonary vein isolation-only was more frequent (93% versus 86%;
P<0.001). At 1-year follow-up, freedom from AF/atrial tachycardia recurrence was similar in the ablation-first versus the ablation after failed AAD group (78% versus 74%, respectively;
P=0.076).
CONCLUSION: In this large real-world PFA registry, freedom from AF/atrial tachycardia recurrence after 1 year was similar in patients undergoing PFA as a first-line treatment and those with prior failed AAD therapy.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05823818.
AB - BACKGROUND: Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy. Examination of real-world data may shed light on clinical practices and the effectiveness of PFA with and without a prior history of AAD usage.METHODS: EU-PORIA is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at 7 high-volume centers in Europe. This subanalysis evaluates patients with a history of class I/III AAD use versus those with no documented history of class I/III AAD use (first-line patients). Patients with incomplete AAD history, long-standing persistent AF, and those undergoing a repeat ablation procedure were excluded. Patients were treated and followed based on institutional standard of care. Any episode of atrial tachycardia or AF lasting longer than 30 s was considered an arrhythmia recurrence.RESULTS: Of 1233 patients enrolled in EU-PORIA, 1091 met the inclusion criteria (mean age, 66 years; 40% females; and persistent AF, 36%). Pulmonary vein isolation-only was used in 90% of the patients, and 10% received extra-PV ablation. Ablation as the first-line approach was chosen in 589 patients, and 502 patients had prior class I/III AAD use. In the first-line PFA group, paroxysmal AF was more frequent (68% versus 59%;
P<0.001), and pulmonary vein isolation-only was more frequent (93% versus 86%;
P<0.001). At 1-year follow-up, freedom from AF/atrial tachycardia recurrence was similar in the ablation-first versus the ablation after failed AAD group (78% versus 74%, respectively;
P=0.076).
CONCLUSION: In this large real-world PFA registry, freedom from AF/atrial tachycardia recurrence after 1 year was similar in patients undergoing PFA as a first-line treatment and those with prior failed AAD therapy.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05823818.
U2 - 10.1161/CIRCEP.124.013088
DO - 10.1161/CIRCEP.124.013088
M3 - Article
C2 - 39601122
SN - 1941-3149
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
M1 - e013088
ER -