Adam Tarkowski

Andrzej Głowniak

Jakub Baran

Katarzyna Wojewoda

Marta Skowrońska

Michał Orczykowski

Piotr Gardziejczyk

Piotr Urbanek

Robert Bodalski

Łukasz Szumowski

Cardiology Journal

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Address for correspondence: Piotr Gardziejczyk, Division of Clinical Electrophysiology, Department of Internal Medicine and Cardiology, Medical University of Warsaw, ul. Lindleya 4, 02–005 Warsaw, Poland, tel: +48 22 5022092,  e-mail: piotrgardziejczyk@gmail.comReceived: 7.09.2024 Accepted: 4.11.2024 Early publication date: 2.12.2024This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.Cardiology Journal2024, Vol. 31, No. 6, 920–921DOI: 10.5603/cj.102484Copyright © 2024 Via MedicaISSN 1897–5593eISSN 1898–018XRESEARCH LETTERINTERVENTIONAL CARDIOLOGYInsights from pulse field energy in patients  with prosthetic mechanical heart valves  undergoing ablation for atrial fibrillationPiotr Gardziejczyk1 , Piotr Urbanek2, Andrzej Głowniak3, Robert Bodalski2,  Marta Skowrońska1, Katarzyna Wojewoda3, Łukasz Szumowski2,  Adam Tarkowski3, Jakub Baran1, Michał Orczykowski21Division of Clinical Electrophysiology, Department of Internal Medicine and Cardiology,  Medical University of Warsaw, Warsaw, Poland 2Arrhythmia Center, National Institute of Cardiology, Warsaw, Poland 3Department of Cardiology, Medical University of Lublin, Lublin, PolandIntroductionPulse field ablation (PFA) is a new energy source used for ablation in patients with atrial fi-brillation (AF) [1].  However, some data advocate its application also in atrial tachycardia ablation [2]. To date, there is limited data on the safety profile of this procedure in patients with prosthetic heart valves, as they are usually excluded from clinical trials and registries [3, 4]. The proximity of pros-thetic material in the heart can reduce the efficacy of high-voltage energy used for PFA due to possible energy dispersion. Additionally, caution should be taken when manipulating any ablation system in the left atrium (LA) due to the risk of catheter entrapment in the mitral prosthetic valve. The present study aimed to present the feasibility and safety profile of PFA with a penta-spline catheter in patients with pros-thetic mechanical heart valves, either in the mitral or aortic position.MethodsIn this observational study, patients were prospectively enrolled with prosthetic heart valves who underwent AF ablation with the novel penta-spline PFA catheter (FaraWave, Farapulse-Boston Scientific Inc., Marlborough, USA). The proce-dures were performed in three electrophysiology centres in Poland by operators experienced in AF ablation in patients with prosthetic valves using different technologies, such as radio-frequency (RF) ablation or cryoablation (CB). All procedures were performed under unconscious sedation or general anaesthesia. In four cases, intracardiac echocardiography imaging (ICE) was used to as-sist with the transseptal puncture, assessment of the catheter-tissue contact and proper function of prosthetic valve discs to avoid catheter entrapment in the mitral valve prosthesis, whereas in the rest of cases fluoroscopy was the only visualisation modality employed to support catheter positioning. Pentaspline PFA catheter (FaraWave, Fara-pulse-Boston Scientific Inc., Marlborough, USA) was introduced through the dedicated 13-Fr steer-able sheath (Faradrive, Farapulse-Boston Scientific Inc., Marlborough, USA) into the LA over the wire. A minimum of four pairs of PFA applications per pulmonary vein were performed, with additional applications performed in different aspects of pul-monary veins if needed in order to obtain pulmo-nary vein isolation (PVI) or to perform posterior wall isolation. The movement of the prosthetic valve discs was recorded before and after each application to ensure its proper function.920 www.cardiologyjournal.orgOut of 598 performed PFA procedures in these centres, 14 patients were enrolled in the final anal-ysis, with a median (IQR) age of 61 (53.25; 69.25), 50% female. In 10 patients (71%) a mitral valve prosthesis was present, whereas aortic prosthetic valves were present in four patients. 3 out of 14 patients had a history of tricuspid valve interven-tion performed in the past. In 9/14 patients, PFA was a redo procedure. The PVI was successfully achieved in all patients, and the posterior wall isolation was performed in 13 patients (93%). The median (IQR) number of PFA applications was 75 (52.75; 89), with a median (IQR) proce-dure time of 67.5 (60.75; 80) minutes. Procedural data were presented in Supplementary Table 1. No acute and peri-procedural complications were noted. All patients had TTE performed after the pro-cedure, which revealed no changes in the function of the prosthetic valve. A mid-term follow-up of a median (IQR) of 160 (101.75; 215) days was avail-able in all patients. In 11 (79%) cases, there were no atrial arrhythmia recurrences of the AF or AT. ConclusionsThe main findings are as follows: firstly, PFA is feasible and has a favourable safety profile in patients with prosthetic heart valves both in the mitral or aortic position. Secondly, PFA can lead to effective and efficient workflow in patients with often enlarged left atria in terms of procedural duration, LA dwell time, and completeness of pul-monary vein isolation. The unquestionable advantage of pulse field energy in this group of patients is the deeper penetration of the energy into the left atrial wall [5], often hypertrophied in patients after cardiac surgery [6]. That is unachievable for any other type of energy while maintaining safety regarding collateral damage. The limitations of the study include small sample size and a non-randomized setting.In conclusion, the application of PFA en-ergy at a short distance to the prosthetic valve in a patient undergoing ablation for AF is safe. Nev-ertheless, more patient data and longer follow-up are mandatory.Data availability statement: Data supporting this study are included within the article.Ethics statement: The research was conducted in accordance with the principles embodied in the Declaration of Helsinki and in accordance with local statutory requirements.Author contributions: All authors have the re-vised manuscript, which is critically for important intellectual content and approval of the final version.Funding: None declared.Acknowledgments: All authors have the revised manuscript, which is critically for important intel-lectual content and approval of the final version.Conflict of interests: None declared.Supplementary material: Supplementary video; Supplementary Table 1. References1. Reddy V, Neuzil P, Koruth J, et al. Pulsed Field Ablation for Pul-monary Vein Isolation in Atrial Fibrillation. Journal of the Ameri-can College of Cardiology. 2019; 74(3): 315–326, doi: 10.1016/j.jacc.2019.04.021.2. Gardziejczyk P, Wlazłowska-Struzik E, Skowrońska M, et al. Pulsed-field ablation using pentaspline catheter as a bail-out strategy for perimitral flutter related to the left atrium ante-rior wall scar. HeartRhythm Case Rep. 2023; 9(12): 906–909, doi: 10.1016/j.hrcr.2023.09.016, indexed in Pubmed: 38204828.3. Turagam MK, Neuzil P, Schmidt B, et al. Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry. Circulation. 2023; 148(1): 35–46, doi:  10.1161/CIRCULATIONAHA.123.064959, indexed in Pubmed: 37199171.4. Urbanek P, Orczykowski M, Bodalski R, et al. Electroporation of Peri-Mitral Atrial Flutter in Patient With Mechanical Pros-thetic Valve. Korean Circ J. 2024; 54(9): 587–589, doi: 10.4070/kcj.2024.0069, indexed in Pubmed: 39195198.5. Younis A, Buck E, Santangeli P, et al. Efficacy of Pulsed Field vs Radiofrequency for the Reablation of Chronic Radiofrequency Ab-lation Substrate: Redo Pulsed Field Ablation. JACC Clin Electro-physiol. 2024; 10(2): 222–234, doi: 10.1016/j.jacep.2023.09.015, indexed in Pubmed: 37978965.6. Scherer M, Dzemali O, Aybek T, et al. Impact of left atrial size re-duction on chronic atrial fibrillation in mitral valve surgery. J Heart Valve Dis. 2003; 12(4): 469–474, indexed in Pubmed: 12918849.www.cardiologyjournal.org 921Piotr Gardziejczyk et al., Pulse field ablation in patients with mechanical heart valve

Insights from pulse field energy in patients with prosthetic mechanical heart valves undergoing ablation for atrial fibrillation

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Insights from pulse field energy in patients with prosthetic mechanical heart valves undergoing ablation for atrial fibrillation

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