Carta-Bergaz Alejandro, Ríos-Muñoz Gonzalo R, Ávila Pablo, Atienza Felipe, González-Torrecilla Esteban, Arenal Ángel
Department of Cardiology, Gregorio Marañón Health Research Institute (IiSGM), Calle Dr. Esquerdo 47, 28007 Madrid, Spain.
Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Instituto de Salud Carlos III, Calle Monforte de Lemos 3-5, 28029 Madrid, Spain.
Biomedicines. 2024 Sep 30;12(10):2232. doi: 10.3390/biomedicines12102232.
Atrial fibrillation (AF), the most common arrhythmia, is associated with increased morbidity, mortality, and healthcare costs. Evidence indicates that rhythm control offers superior cardiovascular outcomes compared to rate control, especially when initiated early after the diagnosis of AF. Catheter ablation remains the single best therapy for AF; however, it is not free from severe complications and only a small percentage of AF patients in the Western world ultimately receive ablation. Ensuring that AF ablation is safe, effective, and efficient is essential to make it accessible to all patients. With the limitations of traditional thermal ablative energies, pulsed field ablation (PFA) has emerged as a novel non-thermal energy source. PFA targets irreversible electroporation of cardiomyocytes to achieve cell death without damaging adjacent structures. Through its capability to create rapid, selective lesions in myocytes, PFA presents a promising alternative, offering enhanced safety, reduced procedural times, and comparable, if not superior, efficacy to thermal energies. The surge of new evidence makes it challenging to stay updated and understand the possibilities and challenges of PFA. This review aims to summarize the most significant advantages of PFA and how this has translated to the clinical arena, where four different catheters have received CE-market approval for AF ablation. Further research is needed to explore whether adding new ablation targets, previously avoided due to risks associated with thermal energies, to pulmonary vein isolation can improve the efficacy of AF ablation. It also remains to see whether a class effect exists or if different PFA technologies can yield distinct clinical outcomes given that the optimization of PFA parameters has largely been empirical.
心房颤动（AF）是最常见的心律失常，与发病率、死亡率及医疗费用增加相关。有证据表明，与心率控制相比，节律控制能带来更好的心血管结局，尤其是在AF诊断后早期启动时。导管消融仍然是AF的最佳单一治疗方法；然而，它并非没有严重并发症，并且在西方世界只有一小部分AF患者最终接受消融治疗。确保AF消融安全、有效且高效对于所有患者都能接受该治疗至关重要。鉴于传统热消融能量的局限性，脉冲场消融（PFA）已作为一种新型非热能来源出现。PFA靶向心肌细胞的不可逆电穿孔以实现细胞死亡而不损伤相邻结构。通过其在心肌细胞中产生快速、选择性损伤的能力，PFA提供了一种有前景的替代方法，具有更高的安全性、缩短的手术时间以及与热能相当（如果不是更优）的疗效。新证据的激增使得跟上最新进展并理解PFA的可能性和挑战变得具有挑战性。本综述旨在总结PFA的最显著优势以及这如何转化到临床领域，其中四种不同的导管已获得CE市场批准用于AF消融。需要进一步研究以探索将先前因热能相关风险而避免的新消融靶点添加到肺静脉隔离中是否能提高AF消融的疗效。鉴于PFA参数的优化在很大程度上是经验性的，不同的PFA技术是否会产生不同的临床结果，或者是否存在类效应，仍有待观察。
