Pulsed Field Ablation of Paroxysmal Supraventricular Tachycardia: A Prospective Multicenter Single-Arm Study in China

BACKGROUND: Pulsed field ablation (PFA) has gained attention in cardiac electrophysiology, but data on its application to paroxysmal supraventricular tachycardia are limited. This study aimed to assess the feasibility and safety of PFA and its combination with radiofrequency ablation for treating paroxysmal supraventricular tachycardia. METHODS: A prospective, multicenter, single-arm study was conducted across 8 centers in China. Patients with atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, or Wolff-Parkinson-White syndrome underwent ablation using a focal point dual-mode PFA/radiofrequency ablation catheter. PFA was used to achieve acute ablation success, with consolidation using PFA for atrioventricular nodal reentrant tachycardia or near-His accessory pathways and radiofrequency ablation for far-His accessory pathways. Primary and secondary end points were acute ablation success and 180-day follow-up success, respectively. RESULTS: A total of 158 patients (77 with atrioventricular nodal reentrant tachycardia, 63 with atrioventricular reentrant tachycardia, 16 with Wolff-Parkinson-White, and 2 with both atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia) completed the trial. Acute ablation was successful in 157 patients (99.37%). The skin-to-skin procedure time was 89.9±35.5 min. The median number of PFA discharges was 12 (8-19) with a median effective PFA discharge time of 4.6 (3.2-6.4) ms. Five patients (4 with atrioventricular reentrant tachycardia and 1 with Wolff-Parkinson-White syndrome) experienced paroxysmal supraventricular tachycardia recurrence during the 180-day follow-up period. One patient had a transient first-degree atrioventricular block resolving in 12 hours, and one patient had a transient third-degree atrioventricular block resolving in 24 hours. No permanent atrioventricular block or other adverse events occurred during the ablation procedure or 180-day follow-up period. CONCLUSIONS: PFA demonstrated the feasibility of the treatment of SVT. Reversible first- and third-degree atrioventricular blocks were observed following ablation in one patient each. The preliminary results indicated the safety and feasibility of a combination of PFA and radiofrequency ablation treatment for atrioventricular accessory pathways although it is impossible to determine the relative contribution of PFA.