Key result
Pulmonary vein antral isolation areas achieved immediately after pulsed field ablation persisted without significant regression at a median of 84 days.
Why the study?
Beyond irreversible electroporation, PFA lesions may have a surrounding zone of reversible electroporation and cell injury that could normalize over time, leaving unclear whether acute electrical PVI regresses.
Does the level of electrical pulmonary vein isolation observed acutely after pulsed field ablation regress over time in patients with paroxysmal atrial fibrillation?
Cohort (n=20)
Does the level of electrical pulmonary vein isolation observed acutely after pulsed field ablation regress over time in patients with paroxysmal atrial fibrillation?
Pulsed field ablation for pulmonary vein isolation creates durable lesions that do not regress in size at 3 months follow-up.
Supports short-term PFA isolation durability in cohort data; hypothesis-generating, needs randomized trials before practice change.
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.
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Kawamura et al. (2021) conducted a cohort in Paroxysmal atrial fibrillation (n=20). Pulsed field ablation (PFA) vs. Immediately after PFA (baseline) was evaluated on Left- and right-sided PV antral isolation areas and nonablated posterior wall area. Pulmonary vein antral isolation areas achieved immediately after pulsed field ablation persisted without significant regression at a median of 84 days.
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