Clin Res Cardiol (2022).

Acute safety and efficacy outcome of pulmonary vein isolation using pulsed field ablation technology
K. Nentwich1, G. Simu1, E. Ene2, A. Berkovitz3, K. Sonne2, J. Müller4, S. Kerber5, T. Deneke3
1RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; 2Klinik für Kardiologie/Rhythmologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; 3Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; 4Herz- und Gefäß-Klinik Campus Bad Neustadt, Bad Neustadt a. d. Saale; 5Kardiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale;

Introduction: Pulsed field ablation (PFA) is a new technology for electrical isolation of pulmonary veins (PVI) using electroporation for irreversible cell death. First data imply a very low complication rate in terms of esophageal lesion, phrenic nerve palsy and pulmonary vein stenosis.  We present our datas of our first patients concerning acute safety and efficacy.

Method: 28 patients with paroxysmal and persistent atrial fibrillation (AF) consecutively underwent PFA ablation including complete PVI of all pulmonary veins in all cases (including 14 redo cases ), mean age 68,3 year, and a mean ejection fraction of 56 %, mean CHADSVASC Score 3. 12 patients had paroxysmal AF, in 15 patients additional posterior wall isolation was performed. Additional anatomical and voltage characterization with CARTO (Biosense Webster) was performed before and after ablation. Post ablation, all patients underwent endoscopic evaluation of the esophagus and  all eligible patients were screened for silent cerebral lesions (SCL)  using cerebral magnetic resonance imaging (MRI).  All acute procedure data and complications were documented.


Results:  In all 27 patients effective PVI using only PFA catheter was achieved (100 %) within a mean procedure time of 81±15 min and a mean fluoroscopy time of 18± 5 min.  In 2 patients left atrial macroreentrant tachycardia was effectively terminated with PFA pulses in the PV-mitral-annular isthmus region.

In no patient an esophageal lesion could be detected (0%). Cerebral MRI was performed  in 12 cases and  revealed SCLs (41 %) in 5 patients (3 patients with multiple lesions, 2 patiens with 3 lesions, max size of 8 mm).  No symptomatic complications including pericardial effusion or access site complications were noted.

Conclusion. PFA is a highly effective method for acute  PVI. No relevant symptomatic complications were noted. Of note, no patient had esophageal injury related to the ablation but 40% of patients undergoing post-ablation MRI had documented SCE. Further data have to be collected to discuss these findings properly.