Real-world Outcomes With PFA in Patients With Symptomatic AF
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EUropean Real-world Outcomes With Pulsed Field AblatiOn in Patients With Symptomatic atRIAl Fibrillation

Lessons From the Multi-centre EU-PORIA Registry

Boris Schmidt; Stefano Bordignon; Kars Neven; Tobias Reichlin; Yuri Blaauw; Jim Hansen; Raquel Adelino; Alexandre Ouss; Anna Füting; Laurent Roten; Bart A. Mulder; Martin H. Ruwald; Roberto Mené; Pepijn van der Voort; Nico Reinsch; Thomas Kueffer; Serge Boveda; Elizabeth M. Albrecht; Christopher W. Schneider; Kyoung Ryul Julian Chun

Disclosures

Europace. 2023;25(7):euad185 

In This Article

Abstract and Introduction

Abstract

Aims: Pulsed field ablation (PFA) is a new, non-thermal ablation modality for pulmonary vein (PV) isolation in patients with atrial fibrillation (AF). The multi-centre EUropean Real World Outcomes with Pulsed Field AblatiOn in Patients with Symptomatic AtRIAl Fibrillation (EU-PORIA) registry sought to determine the safety, efficacy, and learning curve characteristics for the pentaspline, multi-electrode PFA catheter.

Methods and Results: All-comer AF patients from seven high-volume centres were consecutively enrolled. Procedural and follow-up data were collected. Learning curve effects were analysed by operator ablation experience and primary ablation modality. In total, 1233 patients (61% male, mean age 66 ± 11years, 60% paroxysmal AF) were treated by 42 operators. In 169 patients (14%), additional lesions outside the PVs were performed, most commonly at the posterior wall (n = 127). Median procedure and fluoroscopy times were 58 (interquartile range: 40–87) and 14 (9–21) min, respectively, with no differences due to operator experience. Major complications occurred in 21/1233 procedures (1.7%) including pericardial tamponade (14; 1.1%) and transient ischaemic attack or stroke (n= 7; 0.6%), of which one was fatal. Prior cryoballoon users had less complication. At a median follow-up of 365 (323–386) days, the Kaplan–Meier estimate of arrhythmia-free survival was 74% (80% for paroxysmal and 66% for persistent AF). Freedom from arrhythmia was not influenced by operator experience. In 149 (12%) patients, a repeat procedure was performed due to AF recurrence and 418/584 (72%) PVs were durably isolated.

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