Iwanari Kawamura1, Petr Neuzil2, Poojita Shivamurthy1, Jan Petru2, Moritoshi Funasako2, Kentaro Minami2, Kenji Kuroki1, Srinivas R Dukkipati1, Jacob S Koruth1, Vivek Y Reddy3. 1. Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Department of Cardiology, Homolka Hospital, Prague, Czech Republic. 3. Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Homolka Hospital, Prague, Czech Republic. Electronic address: vivek.reddy@mountsinai.org.
Abstract
BACKGROUND: The tissue specificity of pulsed field ablation (PFA) makes it an attractive energy source for pulmonary vein (PV) isolation (PVI). However, beyond each PFA lesion's zone of irreversible electroporation and cell death, there may be a surrounding zone of reversible electroporation and cell injury that could potentially normalize with time. OBJECTIVE: The purpose of this study was to assess whether the level of electrical PVI that is observed acutely after PFA regresses over time. METHODS: In a clinical trial, patients with paroxysmal atrial fibrillation underwent PVI using a biphasic PFA waveform delivered through a dedicated, variably deployable multielectrode basket/flower catheter. Detailed voltage maps were created using a multispline diagnostic catheter immediately after PFA and again ∼3 months later in a prospective, protocol-specified reassessment procedure. We analyzed 20 patients who underwent PFA with durable PVI and available maps from both time points. To compare the ablated zones, the left- and right-sided PV antral isolation areas and nonablated posterior wall area were quantified and the distances between left and right PV low-voltage edges were measured. RESULTS: A comparison of voltage maps immediately after PFA and at a median of 84 days (interquartile range 69-90 days) later revealed that there was no significant difference in either the left- and right-sided PV antral isolation areas or nonablated posterior wall area. The distances between low-voltage edges on the posterior wall were also not significantly different between the 2 time points. CONCLUSION: This study demonstrates that the level of PV antral isolation after PFA with a multielectrode PFA catheter persists without regression.
BACKGROUND: The tissue specificity of pulsed field ablation (PFA) makes it an attractive energy source for pulmonary vein (PV) isolation (PVI). However, beyond each PFA lesion's zone of irreversible electroporation and cell death, there may be a surrounding zone of reversible electroporation and cell injury that could potentially normalize with time. OBJECTIVE: The purpose of this study was to assess whether the level of electrical PVI that is observed acutely after PFA regresses over time. METHODS: In a clinical trial, patients with paroxysmal atrial fibrillation underwent PVI using a biphasic PFA waveform delivered through a dedicated, variably deployable multielectrode basket/flower catheter. Detailed voltage maps were created using a multispline diagnostic catheter immediately after PFA and again ∼3 months later in a prospective, protocol-specified reassessment procedure. We analyzed 20 patients who underwent PFA with durable PVI and available maps from both time points. To compare the ablated zones, the left- and right-sided PV antral isolation areas and nonablated posterior wall area were quantified and the distances between left and right PV low-voltage edges were measured. RESULTS: A comparison of voltage maps immediately after PFA and at a median of 84 days (interquartile range 69-90 days) later revealed that there was no significant difference in either the left- and right-sided PV antral isolation areas or nonablated posterior wall area. The distances between low-voltage edges on the posterior wall were also not significantly different between the 2 time points. CONCLUSION: This study demonstrates that the level of PV antral isolation after PFA with a multielectrode PFA catheter persists without regression.
Authors: Marc D Lemoine; Thomas Fink; Celine Mencke; Ruben Schleberger; Ilaria My; Julius Obergassel; Leonard Bergau; Vanessa Sciacca; Laura Rottner; Julia Moser; Shinwan Kany; Fabian Moser; Paula Münkler; Leon Dinshaw; Paulus Kirchhof; Bruno Reissmann; Feifan Ouyang; Philipp Sommer; Christian Sohns; Andreas Rillig; Andreas Metzner Journal: Clin Res Cardiol Date: 2022-09-22 Impact factor: 6.138