Gunawardene Melanie A, Middeldorp Melissa, Pape Ulrich-Frank, Maasberg Sebastian, Hartmann Jens, Dickow Jannis, Wahedi Rahin, Harloff Tim, Matuschka Sophia, Sultan Arian, Dinov Borislav, Gessler Nele, Sanders Prashanthan, Willems Stephan
Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.
Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, Adelaide, SA 5000, Australia.
Europace. 2025 Aug 4;27(8). doi: 10.1093/europace/euaf133.
Substrate modification, including left atrial posterior wall isolation (LAPWI), may be performed in AF patients undergoing catheter ablation. Pulsed field ablation (PFA) may protect adjacent structures like the esophagus. However, data on esophageal safety following PFA-guided LAPWI are limited. The aim is to evaluate esophageal safety during post-procedural esophagogastroduodenoscopy (EGD) and follow-up after PFA-guided LAPWI in patients with AF.
This prospective observational study included consecutive AF patients who underwent PFA-guided LAPWI and post-procedural EGD (the day after PFA), with follow-up for long-term safety. In total, 106 consecutive patients (94% persistent AF, 66 ± 14 years, 70% male, 2 ± 1 prior ablation procedures) were included. The total median procedure time was 78 [interquartile range (IQR): 49-111] min, and a mean of 50 ± 19 and 21 ± 9 PFA applications were delivered per patient and on the LAPW, respectively. One suspected transient ischaemic attack and three minor complications occurred. No thermal, ablation-related esophageal lesions were observed in any patient during EGD. Non-ablation-related incidental gastrointestinal findings were detected in 70% of patients. During a median follow-up of 606 days [IQR: 212-922], no additional esophageal adverse events were reported. Atrial arrhythmia recurrences occurred in 34% (36/106) patients (including antiarrhythmic drugs). Left atrial posterior wall isolation durability was 78% (11/14).
In this real-world cohort, PFA-guided LAPWI was safe for the esophagus, with no thermal injury observed in post-procedural endoscopy. These results further support PFA as a promising technology for AF ablation with a favourable esophageal safety profile. The role of post-ablation proton pump inhibitors in a population where incidental gastrointestinal findings were common needs further exploration.
在接受导管消融的房颤患者中可进行包括左心房后壁隔离（LAPWI）在内的基质改良。脉冲场消融（PFA）可保护诸如食管等邻近结构。然而，关于PFA引导下LAPWI后食管安全性的数据有限。目的是评估房颤患者在PFA引导下LAPWI术后食管胃十二指肠镜检查（EGD）期间及随访时的食管安全性。
这项前瞻性观察性研究纳入了连续接受PFA引导下LAPWI及术后EGD（PFA术后次日）并进行长期安全性随访的房颤患者。总共纳入了106例连续患者（94%为持续性房颤，66±14岁，70%为男性，既往平均有2±1次消融手术）。总手术时间中位数为78[四分位数间距（IQR）：49 - 111]分钟，每位患者平均进行50±19次PFA应用，左心房后壁平均进行21±9次PFA应用。发生1例疑似短暂性脑缺血发作和3例轻微并发症。EGD期间未在任何患者中观察到与热、消融相关的食管病变。70%的患者检测到非消融相关的偶然胃肠道发现。在中位随访606天[IQR：212 - 922]期间，未报告其他食管不良事件。34%（36/106）的患者发生房性心律失常复发（包括使用抗心律失常药物）。左心房后壁隔离的持久性为78%（11/14）。
在这个真实世界队列中，PFA引导下的LAPWI对食管是安全的，术后内镜检查未观察到热损伤。这些结果进一步支持PFA作为一种有前景的房颤消融技术，具有良好的食管安全性。消融后质子泵抑制剂在偶然胃肠道发现常见人群中的作用需要进一步探索。
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