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Background Pulsed Field Ablation (PFA) is a novel technology increasingly being adopted for atrial fibrillation (AF) ablation. Published data however has thus far shown largely equivalent outcomes to thermal ablation. PFA techniques also vary, with early systems designed for ‘single-shot’ akin to cryo-balloon ablation, while newer systems integrate Electro-Anatomic Mapping (EAM), giving potential to ablate beyond pulmonary veins. We report our single tertiary centre experience of EAM-guided PFA using the Medtronic PulseSelect catheter to treat AF & other arrhythmias over a 12-month period.Methods Patients with refractory atrial arrhythmia were offered & consented to undergo PFA with the PulseSelect system guided by Carto3 EAM (Biosense Webster). Acute success was determined by target area isolation on EAM and arrhythmia non-inducibility. Clinical/procedural safety outcomes were collected immediately post & at 4- & 12-month follow up, evaluating mid-to-long term outcomes.Results From Oct 2024-Oct 2025, we performed 50 PFA AF ablation procedures. Baseline demographics are summarised in table 1 below.19 pts underwent Pulmonary Vein Isolation (PVI) alone (15 de novo and 4 redo). The remainder had PVI consolidation plus additional lines; 27 had Posterior Wall Isolation (PWI) (4 post-hybrid ‘convergent’ ablation); 3 had SVC ablation (including a persistent left-SVC); 4 had cavotricuspid isthmus (CTI) ablation. In total, 24 cases were repeat procedures after previous ablation. We also separately performed PFA for a CTI-dependent flutter, an AV node ablation and a right-sided accessory pathway (figure 1).All procedures were acutely successful. Procedure outcome data is summarised in table 2 below.There were no procedure-related on-table complications. 2 pts complained of pleuro-pericarditic chest pain on ward-transfer post procedure, resolving within 24hrs with no ECG changes seen. 1 pt with known heart failure had pulmonary oedema a few hours post-procedure, but responded well to IV diuresis and was discharged next day. Another had sinus pauses noted at procedure start; following PVI & SVC ablation they became profoundly bradycardic requiring isoprenaline infusion and pacemaker implantation 24hrs later.47 of 50 cases (94%) were discharged within 24hr, though 1 was readmitted a week later due to groin oozing, with only localised infection and no vascular complication on imaging.At follow up (mean interval 4.4±2.3 months), 11 pts had AF recurrence (3 originally PAF, 8 PerAF). All others had AADs stopped at follow up. This corresponds to a mid-term procedure success rate of 78% (82.4% for PAF, 75.8% for PerAF), encouragingly in line with published outcomes. Kaplan Meier curve analysis to estimate recurrence was performed (see figure 2 below).Conclusion PFA is feasible, safe and effective for various cardiac arrhythmia ablation indications. Further data is required on long-term outcomes to assess durability and benefit over existing ablation technologies.Abstract 303 Figure 1PulseSelect PFA catheter used for CTI line ablation (A), Right accessory pathway ablation (B) and AV node ablation (C)Abstract 303 Table 1Baseline demographic datan=50Mean age (years±SD)66±8.2Gender15 female, 35 maleMean BMI (kg/m2±SD)29.4±4.9AF subtype17 paroxysmal (PAF), 33 persistent (perAF)Mean persistent AF duration (months±SD)20.5±16.6LVEF<40%n=6 (12%)Mean CHA2DS2VASc score (±SD)2.1±1.3Anti-arrhythmic (AAD) use pre-procedure (amiodarone/dronedarone/flecainide/sotalol)n=30 (60%)Abstract 303 Figure 2Abstract 303 Table 2Procedure outcomesn=50Mean skin-to-skin procedure duration (mins±SD)131±39.9Mean door-to-door lab time (mins±SD)174±41.4Mean LA dwell time (mins±SD)92.2±30.8Mean fluoroscopy time (mins±SD)23.1±7.65Mean ablation time (seconds±SD)20.8±10.4Mean number of lesions for PVI (±SD)30±14Complications/adverse events-Phrenic nerve injury-Pulmonary stenosis-Pericardial effusion-Oesophageal injury-Pulmonary oedema-Chest pain-Vascular complications-Pacing requirement500001 (known ischaemic cardiomyopathy)2 (no ischaemic changes)1 (nil intervention)1 (baseline conduction disease)Discharge within 24 hoursn=47 (94%)