Comparative analysis of pulmonary vein isolation (PVI) alone versus PCI with additional left atrial posterior wall isolation by pulsed field ablation: a single-centre study.

Abstract

Background: Left atrial posterior wall isolation (LAPWI) presents challenges, particularly with thermal energy sources. Pulsed-field ablation (PFA) offers a new method for achieving this, whilst mitigating procedural complications. Aim(s): Assess the practical feasibility and safety of additional LAPWI using PFA in conjunction with pulmonary vein isolation (PVI), as compared to PVI alone. Method(s): De-identified data from 201 patients undergoing PFA at the Victorian Heart Hospital (VHH) between October 2022 and December 2023 were analysed. Result(s): Demographics and procedurals characteristics are shown in Table 1. The addition of LAPWI prolonged the procedure by an average of 6+/-2.2 minutes and required 25+/-6.5 additional PFA applications. In the PVI + LAPWI group, one major complication occurred at day 7 with acute kidney injury. Anticoagulation was suspended, and the patient experienced a stroke with full resolution. Conversely, the PVI only group experienced three admissions for heart failure and two pericarditis cases. At 30 days, two patients (2.6%) developed atrial arrhythmias in the PVI + LAPWI group compared to seven (5.5%) in the PVI-only cohort. Conclusion(s): The addition of LAPWI by PFA is feasible and safe with minimal procedural duration extension. Longer-term follow-up is required to access efficacy and durability. [Formula presented]Copyright © 2024