Pulmonary vein (PV) stenosis is an important potential complication of PV isolation using thermal modalities such as radiofrequency ablation (RFA). Pulsed field ablation (PFA) is an alternative energy that causes nonthermal myocardial cell death.
Objective
The purpose of this study was to compare the effect of PFA vs RFA on the incidence and severity of PV narrowing or stenosis.
Methods
Data were analyzed from 4 paroxysmal atrial fibrillation ablation trials using either PFA or RFA; because of absent CT scans or poor computed tomography scan quality, 73 of 153 patients (47.7%) were excluded. Baseline and 3-month cardiac computed tomography scans were reconstructed into 3-dimensional images, and the long and short axes of the PV ostia were quantitatively and qualitatively assessed in a randomized blinded manner by 2 physicians.
Results
A total of 299 PVs from 80 patients after either PFA (n = 37) or RFA (n = 43) were enrolled. PV ostial diameters decreased significantly less with PFA than with RFA (% change; long axis: 0.9% ± 8.5% vs −11.9% ± 16.3%; P < .001 and short axis: 3.4% ± 12.7% vs −12.9% ± 18.5%; P < .001). After a combined quantitative/qualitative analysis, mild (30%–49%), moderate (50%–69%), or severe (70%–100%) PV narrowing was observed, respectively, in 9.0% (15 of 166), 1.8% (3 of 166), and 1.2% (2 of 166) of PVs in the RFA cohort but in none of the PVs after PFA (P < .001). Overall, PV narrowing/stenosis was present in 0% and 0% vs 12.0% and 32.5% of PVs and patients who underwent PFA and RFA, respectively.
Conclusion
This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA.
Graphical abstract
Keywords
Atrial fibrillation
Catheter ablation
Electroporation
Nonthermal ablation
Pulmonary vein stenosis
Pulsed field ablation
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Dr VY Reddy is a consultant to and has received stock options in Farapulse, is a consultant to Cardiofocus, and has received grant support from Biosense Webster and Abbott. Dr Reddy also has conflicts with other medical companies unrelated to this manuscript; a full list is provided in the Online Supplemental Appendix. Dr Neuzil has received grant support from Farapulse, Cardiofocus, Biosense Webster, and Abbott. Dr Dukkipati owns stock in Farapulse and Manual Surgical Sciences, serves as a consultant to Cardiofocus, and has received grant support from Biosense Webster. Dr Koruth serves as a consultant to and has received grant support from Farapulse. Mr Eggert, Mr Morrow, and Mr Schneider are the employees of Farapulse. The rest of the authors report no conflicts of interest.