This is a prospective, single-arm intervention trial whereby we will test the safety and efficacy of performing pulmonary vein isolation (PVI) using pulsed field ablation (PFA) in adult patients with congenital heart disease (CHD) who are presenting for atrial tachycardia (AT) ablation.
Adult patients (>= 18 years of age) with repaired or unrepaired congenital heart disease and a history of sustained (>30 seconds) AT
History of sustained AF and/or previous catheter or surgical pulmonary vein isolation.
Single group
Pulsed field ablation using a pentaspline ablation catheter
DeviceAfter conclusion of AT ablation, transseptal or transbaffle puncture will be performed under fluoroscopic and intracardiac echocardiography guidance to access the left atrium (LA) or pulmonary venous atrium (PVA) if not already done so. PFA will be performed using a pentaspline catheter (Farawave, Boston Scientific) and a steerable sheath to achieve PVI of all veins draining to the LA/PVA with entrance and exit block confirmed at each vein. In patients where PFA is unable to achieve PVI, touch-up RFA will be performed. Programmed atrial stimulation will be performed to investigate for inducible atrial tachycardias. An implantable loop recorder will be placed at the conclusion of the procedure.
Acute pulmonary vein isolation
Achievement of entrance and exit block to and from all pulmonary veins draining to the left or pulmonary venous atrium.
Time to atrial tachycardia or atrial fibrillation recurrence
Time to sustained atrial tachycardia (AT) or atrial fibrillation (AF) lasting 30 seconds or more after a 2 month blanking period.
Major adverse event
Composite of stroke, transient ischemic attack, cardiac tamponade requiring percutaneous drainage, phrenic nerve injury \>24 hours, atrioesophageal fistula, pulmonary vein stenosis, and/or any bleeding complication requiring blood transfusion.
AT/AF Burden
Daily burden (measured in hours) of AT/AF as measured on an implantable loop recorder after a 2 month blanking period.
Left atrial/pulmonary venous atrial dwell time
Time with sheath/catheter in left atrium or pulmonary venous atrium.
Case duration
Total procedural duration (minutes)
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Boston Children's Hospital
Lead sponsor
Brigham and Women's Hospital
Collaborator
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