Background: “One-shot” ablation tools are advantaged by ease of use, but are largely limited to PVI - a lesion set inadequate for most non-paroxysmal AF. Using a novel multielectrode basket catheter, we reported PVI with pulsed field ablation (PFA) - an energy that preferentially ablates myocardium. This catheter is deployable in either a basket or flower configuration.
Objective: To describe the acute efficacy and safety of PFA for PVI and LA posterior wall (LAPW) ablation in persistent AF (PerAF) patients.
Methods: PerAF pts were enrolled in PersAFOne (NCT04170621), a single-arm multicenter study of a 13F, 31 or 35mm max dia PFA catheter (Farawave, Farapulse Inc) and a 13F, 13mm max dia deflectable focal catheter (Faraflex). Following PVI, adjunct PWI and other linear ablation was permitted. There was no esophageal monitoring. Electroanatomical mapping systems were used to track study catheters and perform voltage mapping.
Results: 15 pts (65±9 yrs, 80% male, LA 4.5±0.4 cm) were treated with propofol sedation (10 pts) or general anesthesia (5 pts). First-pass PVI occurred in 100% of PVs (58 of 58), requiring 23±9 min in the LA. PWI was successful in 100% (15 of 15) pts using the flower PFA catheter in 14 pts, with ablation at 5.6±1.9 sites and 12±3 min in the LA. The focal catheter was used for linear PWI (1 pt), mitral isthmus block (1 pt) and CTI block (9 pts). Total skin-to-skin time was 116±43 min, including 27±10 min of post-ablation voltage mapping, and 15±7 min of fluoroscopy. No complications occurred, including no esophageal damage by EGD at 3.9±2.2 days (12 pts) despite direct PW ablation.
Conclusion: A single basket/flower PFA catheter can both isolate PVs and ablate the LAPW to treat persistent AF.