Liu Jun, Tang Min, Niu Guodong, Li Chao, Zhang Daoliang, Jiang Yong, Yao Yan, Pan Xiang-Bin
Fuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing, China.
Fuwai Shenzhen Hospital,Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China.
Open Heart. 2025 Apr 5;12(1):e003172. doi: 10.1136/openhrt-2025-003172.
Pulsed-field ablation (PFA) is a new technology of catheter ablation for atrial fibrillation (AF). This research is to investigate the feasibility of a new strategy (transoesophageal echocardiography-guided pulsed field ablation, TEEP) to guide PFA for AF with no contrast and zero fluoroscopy.
Patients with AF underwent TEEP under general anaesthesia with the guidance of three-dimensional (3D) transoesophageal echocardiography (TEE) throughout the procedure. After a successful transseptal puncture, the PFA catheter (CardiPulse) was delivered to the different pulmonary veins sequentially for standard PFA, and the pulmonary vein electrical isolation (PVI) was observed in real-time. After the ablation, left atrial bipolar voltage mapping under sinus rhythm was performed to verify the PVI.
10 patients with AF were enrolled, including 6 patients with paroxysmal AF and 4 patients with persistent AF. The mean operative time was 99±14 min, the mean time of the left atrial manoeuvre was 66±23 min, and the mean PFA ablation time was 105±8 s. First-pass PVI of all veins was achieved in all patients, thus no additional PFA applications were needed after the initial set. No contrast was needed and no X-ray was exposed. No complications were observed.
We report the preliminary application of 3D TEE-guided PFA for AF in the world. Its immediate safety and efficacy are promising. Compared with traditional PFA procedures, TEEP has many advantages, including accuracy of the transeptal puncture, direct visualisation of contact between the catheter and myocardial tissue, no contrast and zero fluoroscopy.
脉冲场消融（PFA）是一种用于心房颤动（AF）的导管消融新技术。本研究旨在探讨一种新策略（经食管超声心动图引导下脉冲场消融，TEEP）在无造影剂和零透视条件下指导AF患者进行PFA的可行性。
AF患者在全身麻醉下接受TEEP，整个过程在三维（3D）经食管超声心动图（TEE）引导下进行。成功进行房间隔穿刺后，将PFA导管（CardiPulse）依次送入不同的肺静脉进行标准PFA，并实时观察肺静脉电隔离（PVI）情况。消融术后，在窦性心律下进行左心房双极电压标测以验证PVI。
纳入10例AF患者，其中阵发性AF患者6例，持续性AF患者4例。平均手术时间为99±14分钟，左心房操作平均时间为66±23分钟，平均PFA消融时间为105±8秒。所有患者均实现了所有静脉的首次PVI，因此初始设置后无需额外进行PFA应用。无需造影剂且未暴露于X射线下。未观察到并发症。
我们报道了全球首例3D TEE引导下PFA用于AF的初步应用。其即时安全性和有效性前景良好。与传统PFA手术相比，TEEP具有许多优势，包括房间隔穿刺的准确性、导管与心肌组织接触的直接可视化、无造影剂和零透视。
