Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.
Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.
Europace. 2021 Nov 8;23(11):1767-1776. doi: 10.1093/europace/euab155.
Pulsed field ablation (PFA), a non-thermal ablative modality, may show different effects on the myocardial tissue compared to thermal ablation. Thus, this study aimed to compare the left atrial (LA) structural and mechanical characteristics after PFA vs. thermal ablation.
Cardiac magnetic resonance was performed pre-ablation, acutely (<3 h), and 3 months post-ablation in 41 patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein (PV) isolation with PFA (n = 18) or thermal ablation (n = 23, 16 radiofrequency ablations, 7 cryoablations). Late gadolinium enhancement (LGE), T2-weighted, and cine images were analysed. In the acute stage, LGE volume was 60% larger after PFA vs. thermal ablation (P < 0.001), and oedema on T2 imaging was 20% smaller (P = 0.002). Tissue changes were more homogeneous after PFA than after thermal ablation, with no sign of microvascular damage or intramural haemorrhage. In the chronic stage, the majority of acute LGE had disappeared after PFA, whereas most LGE persisted after thermal ablation. The maximum strain on PV antra, the LA expansion index, and LA active emptying fraction declined acutely after both PFA and thermal ablation but recovered at the chronic stage only with PFA.
Pulsed field ablation induces large acute LGE without microvascular damage or intramural haemorrhage. Most LGE lesions disappear in the chronic stage, suggesting a specific reparative process involving less chronic fibrosis. This process may contribute to a preserved tissue compliance and LA reservoir and booster pump functions.
脉冲场消融(PFA)是一种非热消融方式,与热消融相比,它可能对心肌组织产生不同的影响。因此,本研究旨在比较 PFA 与热消融后左心房(LA)结构和机械特性的变化。
对 41 例阵发性心房颤动(AF)患者进行了心脏磁共振检查,这些患者在接受肺静脉(PV)隔离时分别接受了 PFA(n=18)或热消融(n=23,16 例射频消融,7 例冷冻消融)。在消融前、消融后 3 小时内和 3 个月时进行了迟发钆增强(LGE)、T2 加权和电影图像分析。在急性期,PFA 后 LGE 体积比热消融大 60%(P<0.001),T2 成像上的水肿小 20%(P=0.002)。PFA 后的组织变化比热消融更均匀,没有微血管损伤或壁内出血的迹象。在慢性期,大多数急性 LGE 在 PFA 后消失,而大多数 LGE 在热消融后仍然存在。PV 窦最大应变、LA 扩张指数和 LA 主动排空分数在 PFA 和热消融后均急性下降,但仅在 PFA 后在慢性期恢复。
脉冲场消融可引起急性 LGE 增加,但无微血管损伤或壁内出血。大多数 LGE 病变在慢性期消失,提示涉及较少慢性纤维化的特定修复过程。这个过程可能有助于保持组织顺应性和 LA 储备和助推泵功能。