Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Farapulse Inc, Menlo Park, California.
Heart Rhythm. 2020 Sep;17(9):1528-1535. doi: 10.1016/j.hrthm.2020.04.040. Epub 2020 May 4.
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.
The purpose of this study was to compare the effect of PFA vs RFA on the incidence and severity of PV narrowing or stenosis.
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 (47.7%) 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.
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.
This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA.
肺静脉（PV）狭窄是使用射频消融（RFA）等热模式进行 PV 隔离的重要潜在并发症。脉冲场消融（PFA）是一种引起非热心肌细胞死亡的替代能源。
本研究旨在比较 PFA 与 RFA 对 PV 变窄或狭窄发生率和严重程度的影响。
对使用 PFA 或 RFA 的 4 项阵发性房颤消融试验的数据进行了分析；由于没有 CT 扫描或 CT 扫描质量差，153 例患者中有 73 例（47.7%）被排除在外。基线和 3 个月的心脏 CT 扫描被重建为 3 维图像，由 2 名医生以随机盲法对 PV 口的长轴和短轴进行定量和定性评估。
共纳入 80 例患者的 299 个 PV，其中 PFA 组（n=37）和 RFA 组（n=43）各有 299 个 PV。与 RFA 相比，PFA 后 PV 口直径的变化明显较小（%变化；长轴：0.9%±8.5% vs -11.9%±16.3%；P<.001和短轴：3.4%±12.7% vs -12.9%±18.5%；P<.001）。在进行定量/定性综合分析后，分别在 RFA 组的 9.0%（15/166）、1.8%（3/166）和 1.2%（2/166）的 PV 中观察到轻度（30%-49%）、中度（50%-69%）或重度（70%-100%）PV 狭窄，而在任何 PFA 后 PV 中均未观察到狭窄（P<.001）。总体而言，分别在 0%和 0%的 PFA 组和 12.0%和 32.5%的 PV 组和患者中观察到 PV 狭窄/闭塞。
本研究表明，与 RFA 不同，PV 隔离后 PFA 几乎消除了 PV 狭窄/闭塞的发生率和严重程度。
