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. 2025 Apr 21.
doi: 10.1007/s10840-025-02046-3. Online ahead of print.

Pulsed field ablation-based pulmonary vein isolation utilizing a simplified approach or a standard approach-insights from the fast and furious PFA study

Christian-H Heeger #  1   2   3 , Leonie Zetzsch #  4 , Charlotte Eitel  4 , Jan-Per Wenzel  4   5 , Sorin Ștefan Popescu  4 , Henning Rolfes  6 , Sascha Hatahet  4 , Behnam Subin  4 , Karl-Heinz Kuck  4 , Roland R Tilz  7   8
Affiliations

Pulsed field ablation-based pulmonary vein isolation utilizing a simplified approach or a standard approach-insights from the fast and furious PFA study

Christian-H Heeger et al. J Interv Card Electrophysiol. .

Abstract

Background: Pulsed field ablation (PFA) is a novel non-thermal energy source. Recently, we developed a tailored and streamlined pulmonary vein isolation (PVI) approach utilizing a pentaspline PFA catheter via a single access, single catheter approach. This study was aimed at comparing safety, efficacy, and follow-up of this approach with a conventional approach.

Methods and results: Fifty consecutive patients with atrial fibrillation (AF) underwent first-time PVI via PFA under deep sedation. The first 25 patients were treated with a conventional approach utilizing two femoral vein access sheath inclusive utilization of 3D mapping and a coronary sinus catheter (conventional approach, control group). The second 25 patients were treated via a simplified single venous, single transseptal puncture, single catheter approach utilizing a vascular closure system (Fast and Furious PFA approach, FAST group). A total of 194 PVs were identified and isolated with PFA only (100%). The median procedural time was 26 (25, 30) min (FAST) and 65 (59, 72) min (control), respectively (P < 0.0001). The median fluoroscopy time was 5 (4, 7) min (FAST) and 12 (10, 14) min (control), respectively (P < 0.001). Freedom from AF recurrence at 12 months was 77% for the FAST group (vs.

Control: 81%, P = 0.856, and overall: 79%).

Conclusion: The combination of a single venous puncture, single transseptal puncture approach utilizing PFA and vascular closure device resulted in a 100% rate of acute PVI and fast procedure with comparable safety, acute efficacy and 12-month outcome to the conventional approach.

Keywords: Acute efficacy; Atrial fibrillation; Pulmonary vein isolation; Pulse field ablation; Venous closure system.

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Conflict of interest statement

Declarations. Conflict of interest: CHH received travel grants and research grants from Boston Scientific, LifTech, Biosense Webster and Haemonetics and speaker honoraria from Boston Scientific, Biosense Webster, Pfizer, Haemonetics, BMS and C.T.I. GmbH and Doctrina Med. CE received travel grants and research grants from Abbott, Boston Scientific, Liftech, Biosense Webster and Cardiofocus and speaker honoraria from Abbott, Boston Scientific, Biosense Webster, Cardiofocus and C.T.I. GmbH and Doctrina Med. SSP received travel and congress sponsoring from LifeTech outside the submitted work. RRT is a consultant for Abbott, Boston Scientific, Biotronik and Biosense Webster and received speaker honoraria from Biosense Webster, Medtronic, Boston Scientific and Abbot Medical. KHK reports grants and personal fees from Abbott Vascular, Medtronic, Biosense Webster outside the submitted work. JPW received travel grants from Boston Scientific and Biosense Webster and speaker honoraria from Abbott and Doctrina Med.

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