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Multicenter Study
. 2024 Apr;10(4):698-708.
doi: 10.1016/j.jacep.2023.11.026. Epub 2024 Feb 7.

Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry

Thomas Kueffer  1 , Stefano Bordignon  2 , Kars Neven  3 , Yuri Blaauw  4 , Jim Hansen  5 , Raquel Adelino  6 , Alexandre Ouss  7 , Anna Füting  3 , Laurent Roten  1 , Bart A Mulder  4 , Martin H Ruwald  5 , Roberto Mené  6 , Pepijn van der Voort  7 , Nico Reinsch  3 , Serge Boveda  6 , Elizabeth M Albrecht  8 , Christopher W Schneider  8 , K R Julian Chun  2 , Boris Schmidt  9 , Tobias Reichlin  10
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Free article
Multicenter Study

Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry

Thomas Kueffer et al. JACC Clin Electrophysiol. 2024 Apr.
Free article

Abstract

Background: Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce.

Objectives: This study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA.

Methods: Patients from 7 European centers undergoing an index PVI using PFA were included the EU-PORIA (European Real-world Outcomes With Pulsed Field Ablation in Patients With Symptomatic Atrial Fibrillation) registry. In patients with subsequent left atrial redo procedures due to arrhythmia recurrence, 3-dimensional electroanatomical maps were acquired. PVI durability was assessed on a per-vein and per-patient level, and sites of reconnections and predictors of lesion durability were identified.

Results: Of 1,184 patients (62% paroxysmal atrial fibrillation) undergoing an index PVI using PFA, 272 (23%) had an arrhythmia recurrence. Of these, 144 (53%) underwent a left atrial redo procedure a median of 7 (Q1-Q3: 5-10) months after the first ablation. Three-dimensional electroanatomical maps identified 404 of 567 pulmonary veins (71%) with durable isolation. In 54 patients (38%), all pulmonary veins were durably isolated. Prior operator experience with cryoballoon ablation was associated with a higher PVI durability compared to operators with only point-by-point radiofrequency experience (76% vs 60%; P < 0.001). Neither the operators' cumulative experience in atrial fibrillation ablation (≤5 vs >5 years) nor the size of the PFA device used (31 mm vs 35 mm) had an impact on subsequent lesion durability (both P > 0.50).

Conclusions: In 144 patients with arrhythmia recurrence after PFA PVI, durable isolation was observed in 71% of the pulmonary veins during the redo procedure, and 38% of all patients showed durable isolation of all veins.

Keywords: atrial fibrillation; pulmonary vein isolation; pulsed-field ablation; reconnection.

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Conflict of interest statement

Funding Support and Author Disclosures The EU-PORIA registry was supported by a research grant from Boston Scientific. Dr Bordignon has received honoraria from Medtronic and Biosense Webster. Dr Neven has served as a consultant for Biosense Webster, Boston Scientific, Field Medical, and LifeTech Scientific. Dr Blaauw has received research grants from Medtronic and Atricure; has received speaker/consulting fees from Abbott/St Jude Medical and Boston-Scientific, all for work outside the submitted study. Dr Hansen has received speaker fees from Boston Scientific and Biosense Webster. Dr Füting has received an educational grant from Boston Scientific. Dr Roten has received research grants from Medtronic and speaker/consulting fees from Abbott and Medtronic. Dr Reinsch has served as a consultant for Boston Scientific. Dr Boveda has served as a consultant for Medtronic, Boston Scientific, Microport, and Zoll. Drs Albrecht and Schneider are salaried employees of Boston Scientific. Dr Chun has served as a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. Dr Schmidt has served as a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. Dr Reichlin has received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation, the Swiss Heart Foundation and the sitem insel support fund, all for work outside the submitted study; has received speaker/consulting fees or travel support from Abbott/St Jude Medical, Biosense Webster, Biotronik, Boston Scientific, and Medtronic; and has received support for his institution’s fellowship program from Abbott/St Jude Medical, Biosense Webster, Biotronik, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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