Kawamura Iwanari, Koruth Jacob
Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 113-8519 Tokyo, Japan.
Rev Cardiovasc Med. 2024 May 23;25(5):187. doi: 10.31083/j.rcm2505187. eCollection 2024 May.
Various ablation technologies with different energy sources are currently being either used or being investigated for atrial fibrillation (AF) ablation. Potential complications continue to occur due to the indiscriminate thermal effects on non-targeted tissues adjacent to the myocardium that are common to all thermal ablation modalities. Pulsed field ablation (PFA) has recently gained significant attention and interest as an approach to AF ablation. PFA uniquely has the ability to circumvent certain complications related to thermal energy. PFA is a non-thermal ablation modality with the potential for unique-tissue selectivity that can minimize damage to collateral cardiac structures. Several PFA systems for AF ablation are currently being investigated. Some PFA systems have been designed to serve as single-shot approaches to achieve pulmonary vein isolation (PVI), and others have focal designs enabling flexible PVI lesion sets as well as linear/focal ablations. Favorable acute success rates and low incidence of complications with short procedure times have been reported with several PFA systems regardless of catheter design (single-shot or focal catheter). Clinical PFA studies in which chronic remapping was conducted, demonstrated pulmonary vein (PV) durability improved with evolutional modifications of pulsed field waveforms/dosing, achieving over 90% PV durability with optimized waveforms. Rare adverse events related to PFA may surface with its increasing use worldwide and as sicker patients get exposed to PFA. We believe that both excitement and vigilance are in order as we embark on yet another new chapter of AF ablation.
目前，各种采用不同能量源的消融技术正在用于或正在研究用于心房颤动（AF）消融。由于所有热消融方式对心肌相邻非靶向组织的普遍热效应，潜在并发症仍会发生。脉冲场消融（PFA）作为一种AF消融方法，最近受到了广泛关注。PFA独特地能够规避某些与热能相关的并发症。PFA是一种非热消融方式，具有独特的组织选择性潜力，可将对心脏旁侧结构的损伤降至最低。目前正在研究几种用于AF消融的PFA系统。一些PFA系统被设计为单次消融方法以实现肺静脉隔离（PVI），其他则采用局部设计，可实现灵活的PVI损伤灶以及线性/局部消融。无论导管设计如何（单次消融或局部导管），几种PFA系统均报告了良好的急性成功率和低并发症发生率以及较短的手术时间。进行慢性重新标测的临床PFA研究表明，随着脉冲场波形/剂量的不断改进，肺静脉（PV）的持久性得到改善，优化波形后PV持久性超过90%。随着PFA在全球范围内的使用增加以及病情较重的患者接受PFA治疗，与PFA相关的罕见不良事件可能会出现。我们认为，在开启AF消融的又一个新篇章时，既要有热情也要保持警惕。
