Ablation of accessory pathways in different anatomical locations using focal pulsed field ablation.

BACKGROUND: Ablation of accessory pathways (AP) is cornerstone for treatment of patients with Wolff-Parkinson-White Syndrome and manifestation of atrioventricular reentry tachycardia. Pulsed field ablation (PFA) is a new type of non-thermal form of energy source delivered to the underlying tissue via the ablation catheter and used for ablation of arrhythmic substrates.

OBJECTIVE: We present the efficiency and long-term outcome of ablation of APs of different localizations using a focal pulsed electrical field.

METHODS: In patients with indication for ablation of AP an electrophysiological study was performed. An ablation catheter was used to map the position of AP insertion. Pulsed electric field was delivered through standard ablation catheter. In left-sided APs the first ablation attempt was within coronary sinus (CS). Patient follow-up was scheduled 1-3 months after the ablation. Additional check-up was performed after 6 and 12 months.

RESULTS: In total 14 patients (3 pediatric) were treated. Termination of AP conduction was achieved in all procedures. The cohort consisted of three right free wall, three posteroseptal and eight left-sided APs. Ablation through CS was successfully utilized in 7 out of 8 patients with left-sided APs. There were no complications reported. Median follow-up was 5.5 months. Conduction recurrence through AP was documented in one patient.

CONCLUSION: Focal PFA for AP shows promising results in terms of efficacy and safety. A high rate of successful termination of left-sided APs by ablation within CS may represent a new standard approach. The safety and efficacy profile of PFA seems to be transferable to pediatric population.