RESUMEN
BACKGROUND: Previous clinical studies on pulmonary vein isolation (PVI) with a radiofrequency balloon (RFB) reported safe and effective procedures using Conventional ablation settings with 20/60-second RF delivery via posterior/anterior (PST/ANT) electrodes. The latest evidence suggests that reducing the application time to 15 seconds (s) on the posterior wall when facing the esophageal region is as effective as applying 20 s. OBJECTIVE: To prospectively assess whether reducing RF time on PST/ANT segments to 15/45 s can ensure sufficient quality of lesion metrics and compare the new Shortened ablation settings with the Conventional one in terms of safety, and effectiveness at 1-year. METHODS: A total of 641 patients from 7 European centers were enrolled in a collaborative registry, with 374 in the conventional RF delivery group and 267 in the shortened RF delivery group. Procedural outcomes, lesion metrics, and safety profiles were assessed and compared between the groups. RESULTS: Freedom of any atrial tachycarrythmias at one year were 85.4% and 88.2% in the SHRT and CONV groups, respectively. The shortened RF delivery strategy was associated with significantly shorter procedure times (median 63.5 vs. 96.5 minutes, P < 0.001) and shortened fluoroscopy exposure (median 10.0 vs. 14.0 minutes, P < 0.001) compared to conventional delivery. Efficacy metrics, including first-pass isolation rates and time to isolation, were comparable between groups. Shortened RF delivery was associated with a lower incidence of procedural complications (1.4% vs. 5.3%, P = 0.04) and optimized thermal characteristics. CONCLUSION: Analyses from the COLLABORATE Registry demonstrate that shortening RF energy delivery times to 15/45s (PST/ANT) during PVI with the RFB resulted in comparable freedom from recurrent atrial tachyarrhythmia compared to conventional delivery times with comparable efficiency and safety.
RESUMEN
BACKGROUND: Treating atrial tachycardia (AT) originating from left atrial appendage (LAA) needs sometimes electrical isolation of LAA. We report a case of AT originating from LAA successfully treated with electrical isolation using the novel lattice-tip pulsed-field/radiofrequency ablation (PFA/RFA) catheter. A 55-year-old female patient with a history of three focal ablative attempts for a highly symptomatic AT originating from the LAA in different centers was admitted to our department for the recurrence of the clinical tachycardia. Electrical isolation of the LAA (LAAEI) was successfully performed with a lattice-tip PFA/RFA ablation catheter. Six weeks after the procedure, an invasive re-mapping study indicated a durable electrical LAA isolation; therefore, a 24-mm-sized LAA occlusion device (WATCHMAN FLX device, Boston Scientific, Plymouth, MN, USA) was implanted. DISCUSSION: In this case, we successfully treated an atrial tachycardia originating from LAA using the recently approved lattice-tip PFA/RFA ablation catheter. The combination between two energy sources during the same procedure could potentially improve lesions transmurality offering a new promising solution for the treatment of complex atrial tachycardias.