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

Ilaria My*, Marc D. Lemoine, Mahi Butt, Celine Mencke, Fabian W. Loeck, Julius Obergassel, Laura Rottner, Jan‐Per Wenzel, Ruben Schleberger, Julia Moser, Fabian Moser, Paulus Kirchhof, Bruno Reissmann, Feifan Ouyang, Andreas Rillig, Andreas Metzner

*Corresponding author for this work

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Abstract

Introduction: Pulsed‐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. Methods: PVI 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. Results: Sixty 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. Conclusion: PFA delivers larger acute lesion areas and higher troponin release upon successful PVI than multielectrode RFB‐based PVI in this single‐center series.
Original languageEnglish
Article number16001
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Early online date20 Jul 2023
DOIs
Publication statusE-pub ahead of print - 20 Jul 2023

Keywords

  • atrial fibrillation
  • pulsed‐field ablation
  • single shot
  • pulmonary vein isolation
  • catheter ablation
  • real‐world
  • radiofrequency balloon

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