Eagle's Eye View: Your Weekly CV Update From ACC.org Eagle's Eye View: Pulsed Field Ablation and Pulmonary Vein Isolation, Penetrance of Dilated Cardiomyopathy in Genotype-Positive Relatives, TAVR or SAVR and Severe Aortic Stenosis
May 1, 2024
Dr. Eagle dives into the effectiveness of pulsed-field ablation for pulmonary vein isolation, revealing its impressive durability statistics. He also explores the genetic nuances of dilated cardiomyopathy, highlighting a significant incidence in genotype-positive relatives. In addition, there's a fascinating comparison of reintervention rates between TAVR and SAVR for severe aortic stenosis, showcasing some unexpected insights into when and why reinterventions occur. Tune in for a blend of cutting-edge research and practical insights!
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PFA Shows Strong Lesion Durability
- Pulsed-field ablation (PFA) achieved 71% pulmonary vein durability and 38% complete patient-level durability in real-world redo procedures.
- PFA durability compares favorably to radiofrequency and cryo (46–64% vein-level; 10–30% patient-level).
Operator Background Affects Outcomes
- Operator background influenced outcomes: prior cryoballoon experience associated with higher PFA durability than RF-only operators.
- Device size and cumulative AF ablation experience did not affect lesion durability.
Genotype-Positive Relatives Have Measurable Risk
- Among genotype-positive relatives without initial cardiomyopathy, about 11% developed dilated cardiomyopathy over three years.
- Risk varied by gene and was higher with older age, abnormal ECG, lower EF, larger LVESD, and sarcomeric variants.