4.6 | The long-term durability of PFA lesions
Despite our study showed a high rate of atrial tachyarrhythmia-free survival at 1-year post-ablation, reconnections were commonly observed in redo cases. In our cohort, we had three patients who underwent a redo procedure. All three patients presented the reconnection sites of LPV and RPV located at the anterior and posterior carina. LAPW was reconnected in one case. MI and CTI were reconnected in all cases. In a recent study by Baptiste Davong et al,12 four patients underwent a redo procedure. two of them showed reconnection of the left superior pulmonary vein, and the other two presented with reconnection of the right inferior pulmonary vein. LAPW was reconnected in one case. MI was reconnected in all cases. The long-term durability of PFA lesions was barely satisfactory. To improve durability, a multielectrode catheter with a biphasic bipolar high-energy waveform, sufficient applications, and stable contact via a steerable sheath should be recommended, which simultaneously has the concerns of severe coronary vasospasm and severe haemolysis. These complications could hinder the use of PFA for PeAF or AFL, where MI or CTI ablation is necessary. During a PFA procedure with a multielectrode catheter and high energy output adjacent to the coronary artery, such as CTI or MI ablation, routine prophylactic parenteral nitroglycerin, either intracoronary or intravenous, should be recommended to prevent severe coronary spasm before the PFA applications.17,18,20,21 Additionally, haemolysis-induced acute kidney injury was observed in some PeAF patients who received a high number of PFA applications with a pentaspline PFA catheter.22 Hydration with high amounts of fluid infusion immediately after the procedure should be recommended in these patients to prevent severe acute kidney injury related to haemolysis.23 Therefore, further large-scale studies with longer-term follow-up periods are required to optimize the parameters and PFA catheter design, ultimately improving long-term durability and minimizing risks.