Atrial fibrillation (AF) is the most common sustained arrhythmia in adult population. According to current guidelines for the management of AF, radiofrequency (RF) ablation (including at least pulmonary vein isolation \[PVI\]) is a validated therapeutic option for persistent AF. Recently, Pulsed-field ablation (PFA) - a new non-thermal energy - has been used to treat paroxysmal and persistent AF with a high success rate in observational studies. This new technology is based on tissue-specificity on myocardium, avoiding collateral damages on adjacent structures. Before confirming a superiority of PFA over existing thermal energies, prospective studies concerning an exclusive population of persistent AF patients are needed, with rigorous assessment of the recurrences using continuous monitoring (insertable cardiac monitor \[ICM\]). PFA efficacy using ICM has never been evaluated. Before considering PFA in therapeutic strategies through large-scale randomized studies using rigorous monitoring of recurrences, preliminary studies are needed in a persistent AF population-only. This pilot cohort study will provide solid data of PFA efficacy (using continuous monitoring of recurrences) for future randomized studies.
Symptomatic persistent AF (continuous episode sustained beyond 7 days)
Refractory, intolerant or unwilling to take ADT
Signed informed consent
Affiliation to medical social coverage.
None
Single group
Persistent atrial fibrillation ablation using Pulsed-field ablation
Procedure/SurgeryPulmonary vein isolation with pulsed-field ablation coupled with 3D electroanatomic mapping. Follow-up with insertable cardiac monitor.
To assess the 12 month-efficacy (absence of atrial arrhythmias recurrences based upon ICM follow-up) after PVI using PFA in patients with persistent AF.
Efficacy will be assessed by the absence of AF/AT (episodes \> 2min) recurrences during a 12-month follow-up period (clinical success) based upon continuous monitoring (ICM). Recurrence will be defined as any AF/AT episode \> 2 min (detected by ICM) after the 2-month blanking period.
Quantify the total atrial arrhythmias burden (AF/AT) over a 12-months period
Efficacy will be assessed by total AF/AT burden (recurrence as defined in the main criterion of evaluation), recorded by the ICM, and defined as the total period of time spent in AF/AT over the 12-month follow-up period (after the 2-month blanking period; assessment period of 10 months)
Assess patient distribution according to residual arrhythmias burden after one year
Residual AF/AT burden will be categorized into 4 groups: 0-0,1%; \>0,1%-1%; \>1-10%; \>10% of the follow-up period. After calculation of the total AF/AT burden of each patient at M12, he will be classified into one of the above categories.
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