Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry

Jun Hirokami; Kyoung Ryul Julian Chun; Stefano Bordignon; Shota Tohoku; Kars Neven; Tobias Reichlin; 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; Thomas Kueffer; Serge Boveda; Elizabeth M Albrecht; Boris Schmidt

doi:10.1111/jce.16583

Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry

Jun Hirokami^*, Kyoung Ryul Julian Chun, Stefano Bordignon, Shota Tohoku, Kars Neven, Tobias Reichlin, 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, Thomas Kueffer, Serge Boveda, Elizabeth M AlbrechtBoris Schmidt

^*Corresponding author for this work

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

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Abstract

BACKGROUND: Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.

OBJECTIVE: This study aims to assess the efficacy and safety of PFA in patients with persistent AF.

METHODS: Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected.

RESULTS: The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87%), mitral isthmus ablation (37%), and cavo-tricuspid isthmus ablation (3%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69% vs. 56%, p = 0.013). While AF recurrence did not significantly differ (25% vs. 28%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8% vs. 22%, p < 0.001). Major complications occurred in 2.0% versus 1.0% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400).

CONCLUSIONS: PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.

Original language	English
Number of pages	11
Journal	Journal of Cardiovascular Electrophysiology
DOIs	https://doi.org/10.1111/jce.16583
Publication status	E-pub ahead of print - 2-Apr-2025

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Hirokami, J., Chun, K. R. J., Bordignon, S., Tohoku, S., Neven, K., Reichlin, T., 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., Kueffer, T., Boveda, S., ... Schmidt, B. (2025). Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry. Journal of Cardiovascular Electrophysiology. Advance online publication. https://doi.org/10.1111/jce.16583

@article{db95d0485e80480290b3d907e6dd9861,

title = "Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry",

abstract = "BACKGROUND: Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.OBJECTIVE: This study aims to assess the efficacy and safety of PFA in patients with persistent AF.METHODS: Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected.RESULTS: The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87\%), mitral isthmus ablation (37\%), and cavo-tricuspid isthmus ablation (3\%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69\% vs. 56\%, p = 0.013). While AF recurrence did not significantly differ (25\% vs. 28\%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8\% vs. 22\%, p < 0.001). Major complications occurred in 2.0\% versus 1.0\% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400).CONCLUSIONS: PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.",

author = "Jun Hirokami and Chun, \{Kyoung Ryul Julian\} and Stefano Bordignon and Shota Tohoku and Kars Neven and Tobias Reichlin 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 Thomas Kueffer and Serge Boveda and Albrecht, \{Elizabeth M\} and Boris Schmidt",

note = "{\textcopyright} 2025 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.",

year = "2025",

month = apr,

day = "2",

doi = "10.1111/jce.16583",

language = "English",

journal = "Journal of Cardiovascular Electrophysiology",

issn = "1045-3873",

publisher = "Wiley",

}

Hirokami, J, Chun, KRJ, Bordignon, S, Tohoku, S, Neven, K, Reichlin, T, Blaauw, Y, Hansen, J, Adelino, R, Ouss, A, Füting, A, Roten, L, Mulder, BA, Ruwald, MH, Mené, R, van der Voort, P, Reinsch, N, Kueffer, T, Boveda, S, Albrecht, EM & Schmidt, B 2025, 'Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.16583

TY - JOUR

T1 - Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry

AU - Hirokami, Jun

AU - Chun, Kyoung Ryul Julian

AU - Bordignon, Stefano

AU - Tohoku, Shota

AU - Neven, Kars

AU - Reichlin, Tobias

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 - Kueffer, Thomas

AU - Boveda, Serge

AU - Albrecht, Elizabeth M

AU - Schmidt, Boris

PY - 2025/4/2

Y1 - 2025/4/2

N2 - BACKGROUND: Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.OBJECTIVE: This study aims to assess the efficacy and safety of PFA in patients with persistent AF.METHODS: Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected.RESULTS: The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87%), mitral isthmus ablation (37%), and cavo-tricuspid isthmus ablation (3%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69% vs. 56%, p = 0.013). While AF recurrence did not significantly differ (25% vs. 28%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8% vs. 22%, p < 0.001). Major complications occurred in 2.0% versus 1.0% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400).CONCLUSIONS: PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.

AB - BACKGROUND: Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.OBJECTIVE: This study aims to assess the efficacy and safety of PFA in patients with persistent AF.METHODS: Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected.RESULTS: The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87%), mitral isthmus ablation (37%), and cavo-tricuspid isthmus ablation (3%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69% vs. 56%, p = 0.013). While AF recurrence did not significantly differ (25% vs. 28%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8% vs. 22%, p < 0.001). Major complications occurred in 2.0% versus 1.0% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400).CONCLUSIONS: PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.

U2 - 10.1111/jce.16583

DO - 10.1111/jce.16583

M3 - Article

C2 - 40171797

SN - 1045-3873

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

ER -

Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry

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