Initial UK Experience of Focal Pulsed Field Ablation

Pulsed field ablation (PFA) offers potential safety and efficacy advantages for catheter ablation. Delivering this energy source using pre-existing contact force sensing catheters and mapping systems is attractive due to familiarity and accessibility.

Retrospective data collection from four centers for cases performed using focal PFA delivered through conventional contact force sensing catheters.

One hundred and twelve cases were included in the study. 80% of the cases were atrial tachycardia/atrial fibrillation ablations and over two thirds of these redo ablation cases; most of these patients (79%) had ablation delivered beyond the pulmonary veins. Twenty-nine cavotricuspid isthmus (CTI) and 29 mitral valve isthmus (MVI) ablations were performed. There was no relationship between center case number and procedure or fluoroscopy time for atrial cases suggesting no evident learning curve with this technology. One stroke occurred acutely, one patient had ST elevation during CTI ablation without sequelae and one had tamponade. Acute success was excellent with all ablations successful, apart from failure to block one MVI. Short-term success rates (median follow-up 5[3] months) were 74% for atrial ablations and 63% for ventricular ablations (45% for ventricular tachycardia, 100% for ventricular ectopic).

This multicenter cohort suggests the versatility of this focal PFA platform. The use of conventional mapping and ablation equipment abrogates any learning curve. The short-term success rates are encouraging for ventricular ectopic and atrial ablation, but the waveform may need optimizing for ventricular tachycardia ablation. Randomized trials are needed to investigate further the success and complication rates with this technology.