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.