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

doi:10.1111/jce.16001

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

J Cardiovasc Electrophysiol. 2023 Sep;34(9):1802-1807. doi: 10.1111/jce.16001. Epub 2023 Jul 20.

Authors

Ilaria My^{1

2}, Marc D Lemoine^{1

2}, Mahi Butt^{1

2}, Celine Mencke^{1

2}, Fabian W Loeck^{1

2}, Julius Obergassel^{1

2}, Laura Rottner^{1

2}, Jan-Per Wenzel^{1

2}, Ruben Schleberger^{1

2}, Julia Moser^{1

2}, Fabian Moser^{1

2}, Paulus Kirchhof^{1

2

3}, Bruno Reissmann^{1

2}, Feifan Ouyang^{1

2}, Andreas Rillig^{1

2}, Andreas Metzner^{1

2}

Affiliations

¹ Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² DZHK, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
³ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.

PMID: 37473404
DOI: 10.1111/jce.16001

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.

Keywords: atrial fibrillation; catheter ablation; pulmonary vein isolation; pulsed-field ablation; radiofrequency balloon; real-world; single shot.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / surgery
Catheter Ablation* / adverse effects
Catheter Ablation* / methods
Catheters
Female
Humans
Male
Middle Aged
Pulmonary Veins* / surgery
Treatment Outcome