Higuchi Satoshi, Gerstenfeld Edward P
Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, California, USA.
Curr Opin Cardiol. 2025 Jan 1;40(1):22-30. doi: 10.1097/HCO.0000000000001181. Epub 2024 Sep 23.
Although pulsed field ablation (PFA) has emerged as an innovative nonthermal catheter ablation modality, recent reports raise concerns about its potential impact on nearby coronary arteries. This review provides a comprehensive overview of the current understanding and future directions regarding the effects of PFA on or near coronary arteries.
Clinical studies have demonstrated the risks of acute transient vasospasm after delivery of PFA, especially with ablation of structures in proximity to the coronary arteries, such as the cavotricuspid and mitral isthmuses. The clinical incidence has been reported to be approximately 0.14%, according to the largest multicenter registry. Nitroglycerin pretreatment has been demonstrated to mitigate vasospastic events. However, early preclinical models indicate that chronic neointimal hyperplasia, tunica media fibrosis and mild coronary artery narrowing may occur, suggesting long-term coronary injury after delivering PFA near coronary arteries.
Despite reducing collateral tissue damage compared with thermal methods, PFA near coronary arteries may require careful procedural planning and proactive use of nitroglycerin to reduce coronary vasospasm. Further research is essential to elucidate the mechanisms underlying PFA-induced coronary spasm, optimize catheter design and placement, and assess the long-term coronary health implications.
尽管脉冲场消融（PFA）已成为一种创新的非热导管消融方式，但近期报告引发了对其对附近冠状动脉潜在影响的担忧。本综述全面概述了目前对PFA对冠状动脉或其附近区域影响的认识以及未来方向。
临床研究已证实PFA术后存在急性短暂性血管痉挛的风险，尤其是在消融靠近冠状动脉的结构时，如腔静脉三尖瓣峡部和二尖瓣峡部。根据最大的多中心注册研究，临床发生率据报道约为0.14%。已证实硝酸甘油预处理可减轻血管痉挛事件。然而，早期临床前模型表明可能会发生慢性内膜增生、中膜纤维化和轻度冠状动脉狭窄，提示在冠状动脉附近进行PFA后存在长期冠状动脉损伤。
尽管与热消融方法相比，PFA可减少周围组织损伤，但在冠状动脉附近进行PFA可能需要仔细的手术规划并积极使用硝酸甘油以减少冠状动脉痉挛。进一步研究对于阐明PFA诱导冠状动脉痉挛的机制、优化导管设计和放置以及评估对长期冠状动脉健康的影响至关重要。
