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.
Heart Rhythm. 2021 Jun;18(6):878-884. doi: 10.1016/j.hrthm.2021.02.020. Epub 2021 Feb 27.
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.
The purpose of this study was to assess whether the level of electrical PVI that is observed acutely after PFA regresses over time.
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.
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.
This study demonstrates that the level of PV antral isolation after PFA with a multielectrode PFA catheter persists without regression.
脉冲场消融（PFA）的组织特异性使其成为肺静脉（PV）隔离（PVI）的有吸引力的能源。然而，在每个 PFA 病变的不可逆电穿孔和细胞死亡区域之外，可能存在一个可恢复电穿孔和细胞损伤的周围区域，随着时间的推移可能会恢复正常。
本研究旨在评估 PFA 后即刻观察到的电 PVI 水平是否随时间推移而消退。
在一项临床试验中，阵发性心房颤动患者接受了通过专用的、可变速展开的多电极篮/花形导管递送的双相 PFA 波形的 PVI。使用多段线诊断导管在 PFA 后即刻和 3 个月后进行前瞻性、协议规定的重新评估程序时，立即创建详细的电压图。我们分析了 20 名接受 PFA 治疗且有持久 PVI 和两个时间点的可用图的患者。为了比较消融区域，定量测量左、右 PV 窦隔离区域和未消融的后壁区域，并测量左、右 PV 低电压边缘之间的距离。
比较 PFA 后即刻和中位数为 84 天（四分位距 69-90 天）的电压图显示，左、右 PV 窦隔离区域或未消融的后壁区域均无显著差异。后壁上低电压边缘之间的距离在这两个时间点也没有显著差异。
这项研究表明，使用多电极 PFA 导管进行 PFA 后 PV 窦隔离的水平没有消退。
