765 pulsed field ablation for pulmonary vein isolation: preliminary results of a single center experience

Abstract Background Pulsed Field Ablation (PFA) is a new and promising non-thermal ablation modality for Pulmonary Vein Isolation (PVI) for the treatment of patients with Atrial Fibrillation (AF). It preferentially ablates myocardial tissue via electroporation leading to minimal effects on surrounding structures. We sought to evaluate safety and efficacy of PFA in our single center experience. Methods PFA was performed at optimized bipolar biphasic waveform using Farapulse system. A protocol of 8 pulses per vein, 4 in the basket configuration and 4 in the flower configuration was followed. The procedure was performed under general anesthesia. Fluoroscopy was used to guide single transseptal puncture. 1 mg of atropine was administered before starting applications. One third of patients underwent CTI ablation using radiofrequency during the same procedure. In one patient we mapped the left atrium before and after ablation using a high-density mapping catheter. Results We prospectively enrolled 21 patients (76% men, age 58,6 ± 9) who underwent PVI using PFA from July to September 2022 for the treatment of Paroxysmal AF (81%) or Persistent AF (19%). Acute pulmonary veins isolation was achieved in the totality of patients. Median skin-to-skin procedure time and catheter dwell time were 56 minutes and 29 minutes respectively. Median fluoroscopy time was 12 minutes. The average number of total applications was 34 ± 4. No adverse events were observed. After a median follow-up of 77 days, we observed early AF recurrence in two patients. Conclusion Preliminary results of our singe center experience confirm that PFA is a safe and effective ablation modality. Pulmonary vein isolation can be achieved very rapidly with short procedural time, catheter dwell time and fluoroscopy time. Further studies are needed to assess durability of the technique.