47 Pulse field ablation in Irish atrial fibrillation. Patient characteristics, safety, and single operator experience from the first 50 cases

IntroductionPulse Field Ablation (PFA) is an exciting novel technology in the field of Atrial Fibrillation (AF). The technology delivers high amplitude electrical pulses with tissue specificity to target myocardium. This technology offers the potential to improve the safety profile and reduce the procedure duration of AF ablation.MethodsThe first 50 cases using the Farawave PFA ablation catheter (Farapulse PFA System, Boston Scientific) from a single operator were included. All patients underwent ablation under general anaesthesia with transoesophageal echocardiogram and uninterrupted anticoagulation. Ultrasound was used to obtain femoral access (table 1).Abstract 47 Table 1Patient characteristicsPatient Characteristics (N=50) Age (yrs) 62 (32 - 81) Male 37 (74) HTN 14 (28) CCF 5(10) IHD 3(6) Stroke 2(4) Diabetes 2(4) Antiarrhythmic Medications ▪ Amiodarone 10(20) ▪ Dronedarone 6(12) ▪ Flecainide 5(10) ▪ Sotalol 5(10) ▪ Mexiletine 1(2) ▪ None 24(48) Type of Atrial Fibrillation ▪ Paroxysmal 22(44) ▪ Persistent 28(56) Index Procedure 42(84) Type of Ablation ▪ PVI Only 29 (58) ▪ PVI and Posterior Wall isolation 18 (36) ▪ Posterior wall isolation only 1(2) ▪ PVI, Posterior Box and Mitral Isthmus line 2(4) Electro-anatomical Mapping used 37(74) Fluoroscopy time (min) 11 (4–26) ResultsThe cohort included 74% male patients with an average age of 62 (32 – 81). The majority of patients had persistent atrial fibrillation (56%), with amiodarone being the most used anti-arrhythmic drug pre-procedure. Electroanatomic mapping using the CARTO 3 mapping system (Biosense Webster) and multielectrode mapping catheter (Pentaray, Biosense Webster) was used in 74% of cases. Acute procedural success was achieved in all 50 patients. Pulmonary vein isolation only (PVI) was performed in 58% of patients, with 42% undergoing additional substrate ablation on the posterior left atrial wall. A mitral isthmus ablation for intra-procedural mitral flutter was safely performed in two patients. (figure 1) The mean fluoroscopy time was 11 minutes (4–26) and was strongly correlated with case number, with a reduction in overall screening time observed with increasing experience. (figure 2) There were no major complications of pericardial tamponade, TIA, stroke, vascular injury, oesophageal injury, phrenic nerve injury or death. All patients were discharged the following day. 49 of the 50 patients were in sinus rhythm at time of discharge.Abstract 47 Figure 1Left atrial electroanatomic maps pre