Izquierdo de Francisco Maria Teresa, Navarro-Manchon Josep, Perez Oscar Cano, Navarro Javier Navarrete, Martinez Carmen Arveras, Gasco Fransciso Javier Chorro, Martinez-Dolz Luis, Asensi Joaquin Osca
Electrophysiology Section, Cardiology Department Hospital Universitari i Politecnic La Fe Valencia Spain.
Instituto de Investigación Sanitaria La Fe (IIS La Fe) Valencia Spain.
J Arrhythm. 2025 Aug 7;41(4):e70171. doi: 10.1002/joa3.70171. eCollection 2025 Aug.
First approved PFA (Pulsed-Field-Ablation) system for pulmonary vein isolation (PVI) has been Farapulse PFA system. The aim was to assess the characteristics of the lesion made by the Farapulse system and its influence on the clinical results.
First 76 consecutive patients referred for PVI and treated with the Farapulse PFA system were included. A voltage and an activation map were performed before and after PVI. An imaginary middle line was measured between the two carinas. Fusion on the posterior wall was defined when the contralateral ablation areas were connected. We arbitrarily defined a narrow corridor as one that measured < 20 mm of healthy tissue (voltage > 0.5 mV).
Post-PVI mapping revealed an unexpected narrow corridor in the posterior wall in 12 (15%) and fusion in 18 (23%) patients. The multivariate analysis revealed that the only independent predictor was the length of the middle inter-carinas line. The length of the middle posterior line was significantly shorter in patients with affectation of the posterior wall (62 ± 2 vs. 71 ± 3 mm, = 0.0001). ROC curve showed that a middle line cutoff value of 65 mm offered a sensitivity and specificity of 80% and 70% (AUC: 0.82; 95% CI: 0.59-0.84). A corridor < 10 mm is associated with slow conduction velocity below 0.7 m/s, but narrow corridor or fusion were not associated with atrial fibrillation recurrences.
30 (40%) patients showed narrow corridor or fusion on the posterior wall. The only independent predictor was the length of the middle inter-carina line.
首个被批准用于肺静脉隔离（PVI）的脉冲场消融（PFA）系统是Farapulse PFA系统。目的是评估Farapulse系统造成的损伤特征及其对临床结果的影响。
纳入连续76例因PVI就诊并接受Farapulse PFA系统治疗的患者。在PVI前后进行电压和激动标测。测量两个隆突之间的假想中线。当对侧消融区域相连时，定义后壁融合。我们将狭窄通道任意定义为健康组织（电压>0.5mV）宽度<20mm的通道。
PVI后标测显示，12例（15%）患者后壁出现意外狭窄通道，18例（23%）患者后壁出现融合。多因素分析显示，唯一的独立预测因素是中间隆突间线的长度。后壁受累患者的中间后线长度明显较短（62±2 vs. 71±3mm，P=0.0001）。ROC曲线显示，中线截断值为65mm时，敏感性和特异性分别为80%和70%（AUC：0.82；95%CI：0.59-0.84）。通道<10mm与传导速度低于0.7m/s相关，但狭窄通道或融合与房颤复发无关。
30例（40%）患者后壁出现狭窄通道或融合情况。唯一的独立预测因素是中间隆突间线的长度。
