Prevalence, Timing, and Impact of Early Recurrence of Atrial Tachyarrhythmias after Pulsed Field Ablation: A Secondary Analysis of the PULSED AF Trial
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(Published version)
Date
2025
Authors
Boersma, L.V.A.
Natale, A.
Haines, D.
DeLurgio, D.
Sood, N.
Marchlinski, F.
Calkins, H.
Hoyt, R.H.
Sanders, P.
Irwin, J.
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Journal article
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Heart Rhythm, 2025; 22(4):884-890
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Lucas V.A. Boersma, Andrea Natale, David Haines, David DeLurgio, Nitesh Sood, Francis Marchlinski, Hugh Calkins, Robert H. Hoyt, Prashanthan Sanders, James Irwin, Douglas Packer, Suneet Mittal, Sarfraz Durrani, Luigi Di Biase, Robert Sangrigoli, Hiroshi Tada, Tetsuo Sasano, Hirofumi Tomita, Teiichi Yamane, Karl-Heinz Kuck, Oussama Wazni, Khaldoun Tarakji, Jeffrey Cerkvenik, Kelly A. van Bragt, Bob G.S. Abeln, Atul Verma
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Abstract
Background: Early recurrence of atrial tachyarrhythmias (ERAT) within 3 months of thermal ablation for atrial fibrillation (AF) is common and often considered transient. Pulsed field ablation (PFA) is a nonthermal energy source in which ERAT is not well described. Objective: The purpose of this study was to analyze ERAT in patients with AF undergoing PFA in the Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF (PULSED AF) trial. Methods This analysis included 294 patients (154 paroxysmal AF and 140 persistent AF) who had ≥10 rhythm assessments during the 90-day blanking period. ERAT was defined as any instance of ≥30 seconds of AF, atrial flutter, or atrial tachycardia on transtelephonic monitoring (weekly and symptomatic) or ≥10 seconds on electrocardiography (at 3 months), both within 90 days. Late recurrence of atrial tachyarrhythmias (LRAT) was defined as observed atrial tachyarrhythmias between 90 days and 12 months. Results: The overall prevalence of ERAT was 27.1% in patients with paroxysmal AF and 31.6% in patients with persistent AF. In patients with ERAT, 73% had ERAT onset within the first month of the procedure. The presence of ERAT was associated with LRAT in patients with paroxysmal AF (hazard ratio 6.4; 95% confidence interval 3.6–11.3) and patients with persistent AF (hazard ratio 3.8; 95% confidence interval 2.2–6.6). Yet, in 29.4% of patients with paroxysmal AF and 34.3% of patients with persistent AF with ERAT, LRAT was not observed. LRAT was positively correlated with the number of ERAT observations. Conclusion: ERAT after PFA predicted LRAT in patients with paroxysmal and persistent AF. However, the concept of a blanking period after PFA is still valid, as approximately one-third of patients with ERAT did not continue to have LRAT during follow-up and may not need reablation.
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Available online 24 June 2024
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© 2024 Heart Rhythm Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).