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Pulsed field ablation for pulmonary vein isolation: real-world experience and characterization of the antral lesion size compared with cryoballoon ablation

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Abstract

Background

Pulsed field ablation (PFA) is a new, non-thermal technology in the treatment of atrial fibrillation (AF). Early investigations have shown a promising safety profile with durable pulmonary vein isolation (PVI) and large antral lesions. However, clinical data remains scarce.

Methods

We investigated a cohort of 43 patients. Twenty-three patients underwent PVI with PFA in our hospital and we analyzed them with regard to procedural characteristics and with regard to the size of acute antral lesion which was estimated by using an electroanatomical map of the left atrium (LA). We compared these data with data of 20 patients who had undergone cryoballon (CB) PVI in our hospital.

Results

We could show acute isolation of all veins in all patients (100% PFA, 100% CB). Post-ablation high-density mapping revealed no early reconnection (0%). The acute antral lesion size of PFA was significantly higher compared to the CB (67.03 ± 12.69% vs. 57.39 ± 10.91%, p = 0.01). In the PFA group, we found no acute phrenic nerve injury, no major or minor bleeding, and no tamponade but one (4.34%) patient suffered from a stroke. Transient hypotension was observed frequently as well as transient bradycardia or asystole episodes requiring right ventricular pacing. In the CB group, no complications occurred. Furthermore, we discuss practical issues on PFA procedures.

Conclusions

PFA is a promising technology with high acute PV isolation rate and large antral lesions compared to CB. However, larger trials with more patients and data on long-term freedom of AF but also complications are needed.

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Authors and Affiliations

  1. Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Lutherplatz 40, 47805, Krefeld, Germany

    Christian Blockhaus, Alexander Bufe & Dong-In Shin

  2. Faculty of Health, School of Medicine, University Witten/Herdecke, 58448, Witten, Germany

    Christian Blockhaus, Jan-Erik Guelker, Ludger Feyen, Alexander Bufe, Melchior Seyfarth & Dong-In Shin

  3. Department of Cardiology, Petrus Hospital, 42283, Wuppertal, Germany

    Jan-Erik Guelker

  4. Department of Diagnostic and Interventional Radiology, Helios Clinic Krefeld, 47805, Krefeld, Germany

    Ludger Feyen

  5. Department of Diagnostic and Interventional Radiology, Helios University Hospital, 42283, Wuppertal, Germany

    Ludger Feyen

  6. Department of Cardiology, Helios University Hospital, 42283, Wuppertal, Germany

    Melchior Seyfarth

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  1. Christian Blockhaus
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Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript. Conceptualization: Christian Blockhaus and Jan-Erik Guelker; formal analysis and investigation: Christian Blockhaus and Ludger Feyen; writing—original draft preparation: Christian Blockhaus and Jan-Erik Guelker; writing—review and editing: Alexander Bufe and Dong-In Shin; supervision: Dong-In Shin and Melchior Seyfarth.

Corresponding author

Correspondence to Christian Blockhaus.

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Waived by the local Institutional Review Board (Ärztekammer Nordrhein, Düsseldorf, Germany) in view of the retrospective nature of this study.

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The authors declare no competing interests.

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Blockhaus, C., Guelker, JE., Feyen, L. et al. Pulsed field ablation for pulmonary vein isolation: real-world experience and characterization of the antral lesion size compared with cryoballoon ablation. J Interv Card Electrophysiol 66, 567–575 (2023). https://doi.org/10.1007/s10840-022-01359-x

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  • DOI: https://doi.org/10.1007/s10840-022-01359-x

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