Abstract
Introduction: Pulsed field ablation (PFA) is a novel nonthermal
ablation approach using rapid electrical pulses to cause cardiac cell
apoptosis via electroporation. Our study aims to investigate the
feasibility and safety of PFA for persistent atrial fibrillation (PeAF).
Methods: 32 consecutive patients diagnosed with PeAF were
enrolled in our study. All patients underwent PFA treatment using the
strategy including pulmonary vein isolation (PVI), left atrial posterior
wall (LAPW) isolation, cavotricuspid isthmus (CTI) block, and mitral
isthmus (MI) block. Acute and follow-up procedure outcomes were
evaluated, and adverse events related to the ablation procedure were
also observed.
Results: One-year survival free from atrial tachyarrhythmia
post-ablation was 65.6%. Acute success rates for PVI, LAPW isolation,
CTI block, and MI block were 100%, 100%, 96.9%, and 81.3%,
respectively. Eleven cases (34.4%) experienced atrial tachyarrhythmia
recurrence, with 8 cases being atrial fibrillation recurrence and 3
cases being atrial flutter recurrence. Three patients underwent repeat
ablation. Minor complications were encountered in 4 patients with
asymptomatic cerebral lesions. Vagal responses were commonly observed
during the procedure. No severe coronary vasospasm or severe haemolysis
occurred in our cohort.
Conclusion: PFA with the strategy including PVI, LAPW
isolation, CTI block, and MI block is feasible, safe, and associated
with a high rate of freedom from atrial tachyarrhythmia recurrence at 1
year in patients with PeAF.