BACKGROUND: Pulmonary vein (PV) stenosis is an important potential complication of PV isolation using thermal modalities such as radiofrequency ablation (RFA). Pulsed field ablation (PFA) is an alternative energy that causes nonthermal myocardial cell death. OBJECTIVE: The purpose of this study was to compare the effect of PFA vs RFA on the incidence and severity of PV narrowing or stenosis. METHODS: Data were analyzed from 4 paroxysmal atrial fibrillation ablation trials using either PFA or RFA; because of absent CT scans or poor computed tomography scan quality, 73 of 153 patients were excluded. Baseline and 3-month cardiac computed tomography scans were reconstructed into 3-dimensional images, and the long and short axes of the PV ostia were quantitatively and qualitatively assessed in a randomized blinded manner by 2 physicians. RESULTS: A total of 299 PVs from 80 patients after either PFA (n = 37) or RFA (n = 43) were enrolled. PV ostial diameters decreased significantly less with PFA than with RFA (% change; long axis: 0.9% ± 8.5% vs -11.9% ± 16.3%; P < .001 and short axis: 3.4% ± 12.7% vs -12.9% ± 18.5%; P < .001). After a combined quantitative/qualitative analysis, mild (30%-49%), moderate (50%-69%), or severe (70%-100%) PV narrowing was observed, respectively, in 9.0% (15 of 166), 1.8% (3 of 166), and 1.2% (2 of 166) of PVs in the RFA cohort but in none of the PVs after PFA (P < .001). Overall, PV narrowing/stenosis was present in 0% and 0% vs 12.0% and 32.5% of PVs and patients who underwent PFA and RFA, respectively. CONCLUSION: This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA.
BACKGROUND: Pulmonary vein (PV) stenosis is an important potential complication of PV isolation using thermal modalities such as radiofrequency ablation (RFA). Pulsed field ablation (PFA) is an alternative energy that causes nonthermal myocardial cell death. OBJECTIVE: The purpose of this study was to compare the effect of PFA vs RFA on the incidence and severity of PV narrowing or stenosis. METHODS: Data were analyzed from 4 paroxysmal atrial fibrillation ablation trials using either PFA or RFA; because of absent CT scans or poor computed tomography scan quality, 73 of 153 patients were excluded. Baseline and 3-month cardiac computed tomography scans were reconstructed into 3-dimensional images, and the long and short axes of the PV ostia were quantitatively and qualitatively assessed in a randomized blinded manner by 2 physicians. RESULTS: A total of 299 PVs from 80 patients after either PFA (n = 37) or RFA (n = 43) were enrolled. PV ostial diameters decreased significantly less with PFA than with RFA (% change; long axis: 0.9% ± 8.5% vs -11.9% ± 16.3%; P < .001 and short axis: 3.4% ± 12.7% vs -12.9% ± 18.5%; P < .001). After a combined quantitative/qualitative analysis, mild (30%-49%), moderate (50%-69%), or severe (70%-100%) PV narrowing was observed, respectively, in 9.0% (15 of 166), 1.8% (3 of 166), and 1.2% (2 of 166) of PVs in the RFA cohort but in none of the PVs after PFA (P < .001). Overall, PV narrowing/stenosis was present in 0% and 0% vs 12.0% and 32.5% of PVs and patients who underwent PFA and RFA, respectively. CONCLUSION: This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA.
Authors: Emmanuel Ekanem; Vivek Y Reddy; Boris Schmidt; Tobias Reichlin; Kars Neven; Andreas Metzner; Jim Hansen; Yuri Blaauw; Philippe Maury; Thomas Arentz; Philipp Sommer; Ante Anic; Frederic Anselme; Serge Boveda; Tom Deneke; Stephan Willems; Pepijn van der Voort; Roland Tilz; Moritoshi Funasako; Daniel Scherr; Reza Wakili; Daniel Steven; Josef Kautzner; Johan Vijgen; Pierre Jais; Jan Petru; Julian Chun; Laurent Roten; Anna Füting; Andreas Rillig; Bart A Mulder; Arne Johannessen; Anne Rollin; Heiko Lehrmann; Christian Sohns; Zrinka Jurisic; Arnaud Savoure; Stephanes Combes; Karin Nentwich; Melanie Gunawardene; Alexandre Ouss; Bettina Kirstein; Martin Manninger; Jan Eric Bohnen; Arian Sultan; Petr Peichl; Pieter Koopman; Nicolas Derval; Mohit K Turagam; Petr Neuzil Journal: Europace Date: 2022-09-01 Impact factor: 5.486