Acute lesion extension following pulmonary vein isolation with two novel single shot devices: Pulsed field ablation versus multielectrode radiofrequency balloon

Abstract

IntroductionPulsed‐field ablation (PFA) and the multielectrode radiofrequency balloon (RFB) are two novel ablation technologies to perform pulmonary vein isolation (PVI). It is currently unknown whether these technologies differ in lesion formation and lesion extent. We compared the acute lesion extent after PVI induced by PFA and RFB by measuring low‐voltage area in high‐density maps and the release of biomolecules reflecting cardiac injury.MethodsPVI was performed with a pentaspline catheter (FARAPULSE) applying PFA or with the compliant multielectrode RFB (HELIOSTAR). Before and after PVI high‐density mapping with CARTO 3 was performed. In addition, blood samples were taken before transseptal puncture and after post‐PVI remapping and serum concentrations of high‐sensitive Troponin I were quantified by immunoassay.ResultsSixty patients undergoing PVI by PFA (n = 28, age 69 ± 12 year, 60% males, 39.3% persistent atrial fibrillation [AF]) or RFB (n = 32, age 65 ± 13 year, 53% males, 21.9% persistent AF) were evaluated. Acute PVI was achieved in all patients in both groups. Mean number of PFA pulses was 34.2 ± 4.5 and mean number RFB applications was 8.5 ± 3 per patient. Total posterior ablation area was significantly larger in PFA (20.7 ± 7.7 cm²) than in RFB (7.1 ± 2.09 cm²; p < .001). Accordingly, posterior ablation area for each PV resulted in larger lesions after PFA versus RFB (LSPV 5.2 ± 2.7 vs. 1.9 ± 0.8 cm², LIPV 5.5 ± 2.3 vs. 1.9 ± 0.8 cm², RSPV 4.7 ± 1.9 vs. 1.6 ± 0.5 cm², RIPV 5.3 ± 2.1 vs. 1.6 ± 0.7 cm,² respectively; p < .001). In a subset of 38 patients, increase of hsTropI was higher after PFA (625 ± 138 pg/mL, n = 28) versus RFB (148 ± 36 pg/mL, n = 10; p = .049) supporting the evidence of larger lesion extent by PFA.ConclusionPFA delivers larger acute lesion areas and higher troponin release upon successful PVI than multielectrode RFB‐based PVI in this single‐center series.

Pulsed-field ablation versus thermal ablation for atrial fibrillation: A meta-analysis

“…Regarding acute efficacy, there was no statistically significant difference between PFA and TA in terms of initial PVI success (OR 1.62; 95% CI 0.21–12.36; P = .64; I 2 = 49%) ( Figure 3 A), 2 , 3 , 10 , 11 , 12 , 15 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 but there was a significant difference in the rate of first-shot PVI (OR 6.82; 95% CI 1.37–34.01; P = .02; I 2 = 96%) ( Figure 3 B). 2 , 3 , 10 , 12 These results were unchanged by the sensitivity analysis, which decreased the heterogeneity by omitting Reddy et al 2 from the initial PVI success data (OR 5.50; 95% CI 0.63–47.76; P = .12; I 2 = 0%) ( Supplemental Figure S1 C) and the rate of first-shot PVI data (OR 12.15; 95% CI 3.96–44.57; P <.01; I 2 = 88.7%) ( Supplemental Figure S1 D).…”

“…PFA procedures had a significantly shorter duration than TA procedures (MD –21.68; 95% CI –32.81 to –10.54; P <.01; I 2 = 95%9) ( Figure 2 A). 2 , 3 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 However, fluoroscopy time was significantly shorter in TA procedures than in PFA procedures (MD 4.53; 95% CI 2.18–6.88; P <.01; I 2 = 97%) ( Figure 2 B). 2 , 3 , 10 , 11 , 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 After sensitivity testing, the heterogeneity of both procedural and fluoroscopy times remained high (I 2 >90%) ( Supplemental Figures S1 A and S1 B).…”

“…There were significantly lower rates of periesophageal and esophageal injuries in the PFA group than in the TA group (OR 0.17; 95% CI 0.06–0.46; P ≤.01; I 2 = 0%) ( Figure 5 C). 2 , 3 , 10 , 11 , 12 , 14 , 15 , 16 , 19 , 21 , 22 , 23 However, the tamponade rate was significantly increased after PFA compared to TA (OR 2.98; 95% CI 1.27–7.00; P = .01; I 2 = 0%) ( Figure 5 D), 2 , 3 , 10 , 12 , 18 as were high-sensitivity troponin levels 10 , 17 , 19 , 20 after omitting Osmancik et al 19 during the sensitivity analysis (MD 421.42; 95% CI 251.49–591.35; P ≤.01; I 2 = 77.1%) ( Supplemental Figure S1 F).…”

Searching for the dream‐team: To whom the palms of victory?

“…basic: atrial fibrillation/atrial arrhythmias, clinical: catheter ablationatrial fibrillation, clinical: catheter ablation-non-RF energy sources Claudio Tondo MD, PhD, FESC, FHRS 1,2…”

“…In this issue of the Journal, My and co‐workers, in a single center experience, report the comparison between two ablation modalities for atrial fibrillation (AF), namely pulse field ablation (PFA) and radiofrequency balloon ablation (RFB) in terms of acute extensive area of lesion 1 . Moreover, they also provide information about the release of biomolecules as expression of the entity of cardiac tissue injury.…”