Zusammenfassung
Die Ablation kardialer Arrhythmien stellt heute eine Standardtherapie in der invasiven Elektrophysiologie dar. Den Schwerpunkt bildet hier das Vorhofflimmern aufgrund dessen hoher Prävalenz. Die Ablation mittels thermischer Energieformen wie der Radiofrequenz- oder Kryoenergie sind die bis heute am häufigsten eingesetzten Techniken. Aufgrund von Limitationen in Bezug auf Effektivität und Sicherheit der thermischen Ablationstechniken kann die Ablation durch die sog. „pulsed field ablation“ (PFA) eine sichere und wirksame Alternative sein. Hierbei handelt es sich um eine nichtthermische Energieform, die durch die Erzeugung kurzer, hochenergetischer elektrischer Impulse effektive Myokardläsionen mittels einer irreversiblen Elektroporation erzeugt. Erste Daten zeigen eine hohe Effektivität bei niedriger Komplikationsrate. Myokardiales Gewebe zeigt eine hohe Spezifität für diese Energieform unter Schonung umliegender Strukturen wie dem Ösophagus, dem N. phrenicus und umliegender Gefäßstrukturen. Daher ist die irreversible Elektroporation eine sehr vielversprechende Technik und hat das Potenzial, die perfekte Energieform für viele Katheterablationen und insbesondere für die Pulmonalvenenisolation zu werden. Im folgenden Beitrag wird eine Übersicht über den aktuellen Stand zur PFA als auch einen Ausblick über zukünftige Behandlungsfelder gegeben.
Abstract
The ablation of cardiac arrhythmias is now standard therapy in invasive electrophysiology with a focus on atrial fibrillation due to its high prevalence. Thermal energy sources such as radiofrequency or cryoablation are the most commonly used techniques to date. Due to limitations in terms of effectiveness and safety because of possible indiscriminate tissue destruction, ablation using pulsed field ablation (PFA) can be a safe and effective alternative to thermal ablation techniques. This is a nonthermal form of energy that creates effective myocardial lesions by means of irreversible electroporation by generating short, high-energy electrical impulses. Preliminary data show high effectiveness with a low complication rate. Myocardial tissue shows a high specificity while sparing surrounding structures such as the esophagus, the phrenic nerve and surrounding vascular structures. Therefore, irreversible electroporation is a very promising technique and has the potential to become the perfect form of energy for many catheter ablations and especially for pulmonary vein isolation. In this article we provide an overview of the current status of PFA as well as an outlook on future fields of treatment.
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N. Reinsch, A. Füting, D. Höwel und K. Neven geben an, dass kein Interessenkonflikt besteht.
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Reinsch, N., Füting, A., Höwel, D. et al. „Pulsed field ablation“. Herzschr Elektrophys 33, 12–18 (2022). https://doi.org/10.1007/s00399-021-00833-9
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DOI: https://doi.org/10.1007/s00399-021-00833-9