Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden,Journal of the American College of Cardiology

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Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2024-05-18 , DOI: 10.1016/j.jacc.2024.05.001
Vivek Y Reddy ₁ , Moussa Mansour ₂ , Hugh Calkins ₃ , Andre d'Avila ₄ , Larry Chinitz ₅ , Christopher Woods ₆ , Sanjaya K Gupta ₇ , Jamie Kim ₈ , Zayd A Eldadah ₉ , Robert A Pickett ₁₀ , Jeffrey Winterfield ₁₁ , Wilber W Su ₁₂ , Jonathan W Waks ₄ , Christopher W Schneider ₁₃ , Elizabeth Richards ₁₃ , Elizabeth M Albrecht ₁₃ , Brad S Sutton ₁₃ , Edward P Gerstenfeld ₁₄ ,

Affiliation

Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, New York, USA.
Massachusetts General Hospital, Boston, Massachusetts, USA.
Johns Hopkins Hospital, Baltimore, Maryland, USA.
Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
NYU Langone Health, Heart Rhythm Center, New York, New York, USA.
Sutter California Pacific Medical Center, San Francisco, California, USA.
Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, USA.
Catholic Medical Center, Manchester, New Hampshire, USA.
MedStar Washington Hospital Center, Washington, DC, USA.
St Thomas Midtown Hospital, Nashville, Tennessee, USA.
Medical University of South Carolina, Charleston, South Carolina, USA.
Banner University Medical Center, Phoenix, Arizona, USA.
Boston Scientific Corp, St Paul, Minnesota, USA.
University of California San Francisco, San Francisco, California, USA.

The ADVENT randomized trial revealed no significant difference in 1-year freedom from atrial arrhythmias (AA) between thermal (radiofrequency/cryoballoon) and pulsed field ablation (PFA). However, recent studies indicate that the postablation AA burden is a better predictor of clinical outcomes than the dichotomous endpoint of 30-second AA recurrence. The goal of this study was to determine: 1) the impact of postablation AA burden on outcomes; and 2) the effect of ablation modality on AA burden. In ADVENT, symptomatic drug-refractory patients with paroxysmal atrial fibrillation underwent PFA or thermal ablation. Postablation transtelephonic electrocardiogram monitor recordings were collected weekly or for symptoms, and 72-hour Holters were at 6 and 12 months. AA burden was calculated from percentage AA on Holters and transtelephonic electrocardiogram monitors. Quality-of-life assessments were at baseline and 12 months. From 593 randomized patients (299 PFA, 294 thermal), using aggregate PFA/thermal data, an AA burden exceeding 0.1% was associated with a significantly reduced quality of life and an increase in clinical interventions: redo ablation, cardioversion, and hospitalization. There were more patients with residual AA burden <0.1% with PFA than thermal ablation (OR: 1.5; 95% CI: 1.0-2.3; = 0.04). Evaluation of outcomes by baseline demographics revealed that patients with prior failed class I/III antiarrhythmic drugs had less residual AA burden after PFA compared to thermal ablation (OR: 2.5; 95% CI: 1.4-4.3; = 0.002); patients receiving only class II/IV antiarrhythmic drugs pre-ablation had no difference in AA burden between ablation groups. Compared with thermal ablation, PFA more often resulted in an AA burden less than the clinically significant threshold of 0.1% burden. (The FARAPULSE ADVENT PIVOTAL Trial PFA System vs SOC Ablation for Paroxysmal Atrial Fibrillation [ADVENT]; )

中文翻译：

脉冲场与传统热消融治疗阵发性心房颤动：复发性房性心律失常的负担

ADVENT 随机试验显示，热消融（射频/冷冻球囊）和脉冲场消融 (PFA) 之间 1 年无房性心律失常 (AA) 的情况没有显着差异。然而，最近的研究表明，消融后 AA 负担比 30 秒 AA 复发的二分终点更能预测临床结果。本研究的目的是确定：1）消融后 AA 负担对结果的影响； 2) 消融方式对 AA 负担的影响。在 ADVENT 中，有症状的药物难治性阵发性房颤患者接受了 PFA 或热消融。每周收集消融后电话心电图监测记录或收集症状，并在 6 个月和 12 个月时进行 72 小时动态心电图监测。 AA 负担是根据动态心电图和电话心电图监测仪上的 AA 百分比计算的。生活质量评估是在基线和 12 个月时进行的。从 593 名随机患者（299 名 PFA，294 名热患者）中，使用汇总的 PFA/热数据发现，AA 负担超过 0.1% 与生活质量显着下降和临床干预措施（重做消融、心脏复律和住院治疗）的增加相关。与热消融相比，PFA 治疗后残留 AA 负担 <0.1% 的患者更多（OR：1.5；95% CI：1.0-2.3；= 0.04）。通过基线人口统计学对结果进行的评估显示，与热消融相比，既往使用 I/III 类抗心律失常药物失败的患者在 PFA 后残余 AA 负担较少（OR：2.5；95% CI：1.4-4.3；= 0.002）；消融前仅接受 II/IV 类抗心律失常药物的患者在消融组之间的 AA 负荷没有差异。与热消融相比，PFA 更常导致 AA 负荷低于 0.1% 负荷的临床显着阈值。（FARAPULSE ADVENT PIVOTAL 试验 PFA 系统与 SOC 消融治疗阵发性心房颤动 [ADVENT]；）

更新日期：2024-05-18

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