Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Institute for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Pacing Clin Electrophysiol. 2023 Jul;46(7):714-716. doi: 10.1111/pace.14727. Epub 2023 May 29.
Pulsed field ablation (PFA) results in unique lesion formation, but there is lack of in-vivo validation in terms of scar formation following atrial fibrillation (AF) ablation.
We aimed to access atrial lesion formation based on late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) following PFA for pulmonary vein (PV) and posterior wall isolation (PWI).
AF ablation was performed in 10 patients using a 31 mm pentaspline PFA catheter. After pulmonary vein isolation (PVI; n = 8 PFA-applications/ PV; n = 4 in basket and n = 4 in flower configuration), another eight applications in flower configuration were conducted for concomitant PWI. Patients underwent LGE CMR 3 months after ablation aiming for quantification of left atrial (LA) scar.
Acute procedural success was achieved in all patients. Mean procedure duration was 62 ± 7 min. and mean LA dwell time of the PFA catheter was 13 ± 2 min. Mean post ablation total LA scar burden was 8.1 ± 2.1% and mean scar width was 12.8 ± 2.1 mm. At the posterior LA, 22.6 ± 2.2% of the anatomical segment resulted in chronic scar tissue, concentrated at the PW. Postablation CMR found no evidence for PV stenosis or collateral damage of adjacent structures. At 7 months of follow-up, 9/10 patients (90%) were free from arrhythmia recurrence.
PFA for AF resulted in durable and transmural atrial scar tissue at the PVs and PW. LGE CMR found a very homogeneous and contiguous lesion pattern with no signs for collateral damage.
脉冲场消融（PFA）可导致独特的病变形成，但在心房颤动（AF）消融后瘢痕形成方面缺乏体内验证。
我们旨在通过 PFA 进行肺静脉（PV）和后侧壁隔离（PWI）后，基于晚期钆增强（LGE）心血管磁共振成像（CMR）评估心房病变形成。
对 10 例患者使用 31mm 五边形 PFA 导管进行 AF 消融。在进行肺静脉隔离（PVI；n=8 PFA 应用/PV；n=4 个篮子和 n=4 个花型）后，进行另外 8 次花型构型的应用以进行同时的 PWI。消融后 3 个月，患者接受 LGE CMR 检查，旨在量化左心房（LA）瘢痕。
所有患者均获得急性手术成功。平均手术时间为 62±7 分钟，PFA 导管的平均 LA 停留时间为 13±2 分钟。平均消融后总 LA 瘢痕负荷为 8.1±2.1%，平均瘢痕宽度为 12.8±2.1mm。在后 LA，22.6±2.2%的解剖段出现慢性瘢痕组织，集中在后壁。消融后 CMR 未发现 PV 狭窄或相邻结构的旁道损伤的证据。在 7 个月的随访中，10 例患者中的 9 例（90%）无心律失常复发。
AF 的 PFA 导致 PV 和 PW 处持久且透壁性的心房瘢痕组织。LGE CMR 发现了非常均匀和连续的病变模式，没有旁道损伤的迹象。
