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CLEAR FILTERS
Impact of pulsed field ablation on left atrial function
Session:
Sessão de Posters 05 - Ablação por campo pulsado: da viabilidade à fisiologia
Speaker:
Inês Rodrigues
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Inês Arrobas Rodrigues; António Gonçalves; Marta Almeida; André Lobo; Rafael Teixeira; Mafalda Carrington; João Almeida; Marco Oliveira; Silvia Diaz; Francisco Sampaio; Paulo Fonseca; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background and aim</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pulsed field ablation (PFA) is a novel, non-thermal and selective atrial fibrillation (AF) ablation modality based on the process of irreversible electroporation. It holds the promise of creating transmural and durable lesions while reducing the risk of collateral damage. Its impact on left atrium (LA) function, however, remains unclear. This study evaluated the effects of PFA on LA function.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This prospective observational study included all patients undergoing AF ablation with PFA between March and October 2025. LA function was assessed using LA strain (LAS) before the procedure (T1), the day after (T2), and at 3-month follow-up (T3). Study endpoints were temporal changes in LAS across the 3 time points and differences in LAS variation between patients undergoing pulmonary vein isolation (PVI) alone versus PVI plus additional posterior wall (PW) lesions.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">73 patients (35.6% female; median age 67 [IQR 59.5–72]; 58.9% persistent AF) underwent PVI with PFA, of whom 23.3% had additional PW lesions. Median LA volume was 40 mL/m² (35–48) and mean LVEF was 57.8±8.2%. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The proportion of patients in sinus rhythm (SR) differed significantly across time points (60.5% at T1, 98.4% at T2, 93% at T3).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the overall cohort, mixed-effects modelling showed no significant changes in reservoir LA strain (LARS) across time points (20.3% [95%CI 17.1–23.5] at T1, 19.9% [95%CI 17.8–22] at T2, 23.3% [95%CI 20.5–26] at T3, overall p=0.092). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Among patients in SR, baseline LARS was higher (25.1%, 95%CI 21.9–28.2). After ablation, LARS significantly decreased (20.2%, 95%CI 18.5–22.3; p=0.005) and recovered at T3 to values comparable to baseline (24.1% [95%CI 21.3–26.8]; p<sub>T2–T3</sub>=0.04; p<sub>T1–T3</sub>=1.00). Contractile LAS showed a similar pattern; conduit LAS remained unchanged.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Compared with PVI alone, patients receiving additional PW lesions had larger LA volumes (47.5 [IQR 42–4.8] vs 42 [IQR 37.8–46.2], p=0.031) and lower T1 LARS (11.7% [IQR 5.9–16.6] vs 26.7% [IQR 12.7–36], p=0.049). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Additional PW lesions were associated with poorer LARS recovery at T3 (ΔLARS<sub>T3–T2</sub> = +6.0% [95%CI 2.7–9.2] for PVI vs –2.8% [–9.3 to 3.2] for PVI+PW, p=0.024). Despite a similar trend for contractile LAS, the difference between groups did not reach statistical significance. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AF ablation with PFA resulted in a transient reduction in LARS, that fully recovered at 3 months. Additional PW lesions were associated with poorer LARS recovery at 3 months, compared with PVI alone.</span></span></p>
Slides
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