Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, 30174 Mestre-Venice, Italy.
Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy.
Medicina (Kaunas). 2024 May 16;60(5):817. doi: 10.3390/medicina60050817.
Pulsed Field Ablation (PFA) is the latest and most intriguing technology for catheter ablation of atrial fibrillation, due to its capability to generate irreversible and cardiomyocytes-selective electroporation of cell membranes by delivering microsecond-lasting high-voltage electrical fields, leading to high expectations. The first trials to assess the clinical success of PFA, reported an arrhythmia-free survival at 1-year of 78.5%, while other trials showed less enthusiastic results: 66.2% in paroxysmal and 55.1% in persistent AF. Nevertheless, real world data are encouraging. The isolation of pulmonary veins with PFA is easily achieved with 100% acute success. Systematic invasive remapping showed a high prevalence of durable pulmonary vein isolation at 75 and 90 days (range 84-96%), which were significatively lower in redo procedures (64.3%). The advent of PFA is prompting a reconsideration of the role of the autonomic nervous system in AF ablation, as PFA-related sparing of the ganglionated plexi could lead to the still undetermined effect on late arrhythmias' recurrences. Moreover, a new concept of a blanking period could be formulated with PFA, according to its different mechanism of myocardial injury, with less inflammation and less chronic fibrosis. Finally, in this review, we also compare PFA with thermal energy.
脉冲场消融（PFA）是导管消融治疗心房颤动的最新技术，因其能够通过传递微秒持续的高压电场，对细胞膜进行不可逆的和心肌细胞选择性的电穿孔，从而产生很高的期望。评估 PFA 临床成功的首次试验报告称，1 年无心律失常生存率为 78.5%，而其他试验结果则不那么乐观：阵发性房颤为 66.2%，持续性房颤为 55.1%。然而，真实世界的数据令人鼓舞。用 PFA 隔离肺静脉可实现 100%的急性成功率。系统的侵入性重映射显示，在 75 天和 90 天（范围 84-96%）的高持久性肺静脉隔离的发生率很高，在再次手术中则显著降低（64.3%）。PFA 的出现促使人们重新考虑自主神经系统在房颤消融中的作用，因为 PFA 相关的神经节丛保留可能会对晚期心律失常复发产生尚未确定的影响。此外，根据其不同的心肌损伤机制，PFA 可能会形成一个新的空白期概念，其炎症和慢性纤维化程度较低。最后，在这篇综述中，我们还将 PFA 与热能进行了比较。
