{"id":"90183076a84d","type":"article","url":"https://hartvaat.nl/2026/02/04/pulsed-field-ablatie-bereikt-vaker-complete-achterwandisolatie-dan-radiofrequent/","title":"Pulsed-field-ablatie bereikt vaker complete achterwandisolatie dan radiofrequente ablatie bij persisterend atriumfibrilleren","title_en":"Clinical outcomes of pulsed field versus radiofrequency ablation, incorporating posterior wall isolation, in persistent atrial fibrillation","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["advent-trial","pulmonaalvenenisolatie","pulsed-field-ablatie","pulsed-field-ablatie-atriumfibrilleren","varipure"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003798?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003798?rss=1","authors":["Ahmed","O.","Li","A.","Zazai","I.","Bajpai","A.","Zuberi","Z.","Norman","M.","Leung","L.","Specterman","M. J.","Sohal","M.","Behr","E. R.","Saba","M.","Kaba","R. A."],"significance":6,"published":"2026-02-04","source_date":"2026-02-04","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"Persistent atrial fibrillation (AF) remains difficult to treat with catheter ablation. The left atrial posterior wall is a potentially important substrate, but adjunctive posterior wall isolation (PWI) with thermal ablation did not improve outcomes in trials — possibly due to technical limitations. Pulsed-field ablation (PFA) is a non-thermal technique that selectively targets myocardium and may make PWI safer and more consistent. In this real-world cohort (200 patients, 100 PFA and 100 RFA, with combined pulmonary vein and posterior wall isolation), PFA achieved near-universal complete PWI (99% vs 65%), with shorter procedure and left-atrial dwell times. Major non-vascular complications were rare (1.5%) and similar. At 12 months, freedom from recurrent atrial tachyarrhythmia was higher with PFA (70% vs 54%). PFA thus appears to achieve complete posterior wall isolation more often and fewer recurrences than RFA — randomised studies should confirm the role of PWI with PFA.","created":"2026-07-03T10:32:26Z","updated":"2026-07-03T18:39:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Persisterend atriumfibrilleren (AF) blijft lastig te behandelen met katheterablatie. De achterwand van het linkeratrium is een mogelijk belangrijk substraat, maar aanvullende achterwandisolatie (PWI) met thermische ablatie verbeterde de uitkomsten in trials niet — mogelijk door technische beperkingen. Pulsed-field-ablatie (PFA) is een niet-thermische techniek die selectief myocard treft en PWI veiliger en consistenter kan maken. In dit real-world cohort (200 patiënten, 100 PFA en 100 RFA, met gecombineerde longvene- en achterwandisolatie) bereikte PFA vrijwel altijd een complete PWI (99% vs. 65%), met kortere proceduretijd en kortere verblijfsduur in het linkeratrium. Ernstige niet-vasculaire complicaties waren zeldzaam (1,5%) en vergelijkbaar. Na 12 maanden was de vrijheid van recidief-atriumtachyaritmie hoger met PFA (70% vs. 54%). PFA lijkt dus vaker complete achterwandisolatie en minder recidieven te geven dan RFA — gerandomiseerde studies moeten de rol van PWI met PFA bevestigen.","abstract_original":"<sec><st>Background</st>\n<p>Persistent atrial fibrillation (AF) remains challenging to treat with catheter ablation. The left atrial posterior wall (PW) may represent an important non-pulmonary vein (PV) substrate; however, randomised trials have not demonstrated improved outcomes with adjunctive PW isolation (PWI), potentially reflecting technical limitations of thermal ablation rather than a lack of mechanistic relevance. Pulsed-field ablation (PFA) is a non-thermal ablation modality that selectively targets myocardial tissue and may enable safer and more consistent PWI. We compared real-world outcomes of PFA and radiofrequency ablation (RFA) for combined PV isolation and PWI in patients with persistent AF.</p>\n</sec>\n<sec><st>Methods</st>\n<p>200 consecutive patients (100 PFA and 100 RFA) undergoing combined PVI and PWI were retrospectively followed for up to 12 months. Baseline characteristics were broadly similar; however, PFA patients had lower left ventricular ejection fraction (LVEF) (43.5% (35.5&ndash;55.5%) vs 47% (40&ndash;58), p=0.01) and higher CHA<SUB>2</SUB>DS<SUB>2</SUB>-VA risk score (3 (2&ndash;4) vs 2 (1&ndash;3), p=0.01). Primary outcomes were acute procedural success and freedom from recurrent atrial tachyarrhythmia (AT) at 6 and 12 months.</p>\n</sec>\n<sec><st>Results</st>\n<p>PFA achieved near-universal PWI compared with RFA (99% vs RFA: 65%, p&lt;0.005), with shorter procedure duration (106 vs 143.5 min, p&lt;0.005), reduced left atrial dwell time (62 vs 98 min, p&lt;0.005), and faster time to PVI and PWI (all p&lt;0.005). Major non-vascular complications were uncommon (1.5%) and similar between groups. At 12 months, freedom from recurrent AT was higher with PFA (70% vs RFA 54%, p=0.03), with lower odds of first detected AT recurrence in adjusted time-to-event analysis (OR 0.46 (0.26&ndash;0.82), p=0.009).</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>In this real-world cohort, PFA was associated with a higher rate of acute PWI and greater freedom from AT compared with RFA, without a signal of increased complications. Prospective randomised studies are needed to define the role of PWI delivered with PFA in patients with persistent AF, including those with reduced LVEF.</p>\n</sec>"}