https://doi.org/10.1007/s00392-025-02625-4
1Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin | CBF Berlin, Deutschland
Introduction:
Pulsed field ablation (PFA) is an emerging non-thermal ablation method leading to irreversible electroporation by application of rapid electrical pulses. It is known that pulmonary vein isolation (PVI) using PFA creates wide, antral lesions. Yet data on lesion regression and durability is scarce, especially as every PFA-system uses different ablation parameters.
In this case series, we present the first repeat procedures using high density mapping after an index PFA procedure with the Varipulse and the PulseSelect system.
Methods:
Consecutive patients who presented for RFA repeat procedure after an initial PFA PVI were included. Patients underwent high-density re-mapping using an Octaray catheter to assess PV lesion regression and PV reconnection compared to the index procedure. Peak-to-peak electrogram bipolar amplitude < 0,5 mV was defined as low-voltage area threshold. Location of PV reconnections were noted and potential regression of the ablation lesions was measured a) at the left atrial roof (line 1), b) and at the minimal distance between the PV lesions (line 2), c) the inferior border of the pulmonary veins (line 3) and compared to the post ablation map of the index procedure.
Results:
Four patients were included. Mean time between first and second ablation was 3 months.
Three patients were initially treated with the PulseSelect system (cases 1-3), one patient was treated with the Varipulse system (case 4). Baseline characteristics are shown in table 1. Results are shown in table 2. Overall, lesion regression was 11,2 + 3,2 mm (see table 2). Two patients underwent left atrial substrate modification, two other patients had PV reconnections (see pictures 1-4) which were reisolated.
Conclusion:
To our knowledge, this case series is the first to describe interlesion regression after PFA with PulseSelect and Varipulse system. Our cases demonstrate lesion regression in all patients. Future studies are needed to confirm the finding and evaluate if lesion regression per se is associated with AF recurrence.
Table 1: Baseline characteristics
|
Parameter |
PulseSelect (n=3) |
Varipulse (n=1) |
|
BMI, mean ± SD (kg/m2) |
28.29 ± 2.2 |
22.1 |
|
Age, mean ±SD (years) |
53.2 ±13.7 |
79.9 |
|
Female, n (%) |
1 (33) |
1 (100%) |
|
LAVI, mean ± SD (ml/m2) |
40 ± 0 |
47 |
|
LVEF, mean ± SD (%) |
53.0 ±7.2 |
65 |
|
DMT, n (%) |
1 (33) |
0 |
|
Arterial hypertension, n (%) |
2 (67%) |
1 |
|
Paroxysmal AF, n (%) |
0 |
1 |
|
CHADS-Va Score, mean + SD |
2.3 ± 2.5 |
3 |
|
Procedure duration (skin to skin, initial procedure), mean + SD (min) |
66 ± 3.2 |
52 |
|
Dose area product, mean + SD (initial procedure, µGy*m2) |
208.7 ± 69.3 |
300 |
|
Complications, n (initial procedure) |
1 (transient phrenic nerve paralysis) |
0 |
Table 2: Electroanatomical characteristics
|
Re-connection of PV, n (%) |
2 (50) |
|
Mapping in sinus rhythm, (%) |
4 (100) |
|
Line 1 (first procedure, mm + SD) |
18.5 + 5.6 |
|
Line 1 (repeat procedure, mm + SD) |
32.5 + 5.2 |
|
Delta line 1 (mm + SD) |
13.9 + 4.1 |
|
Line 2 (first procedure, mm + SD) |
14.9 + 3.2 |
|
Line 2 (repeat procedure, mm + SD) |
24.4 + 4.5 |
|
Delta line 2 (mm + SD) |
9.4 + 7.4 |
|
Line 3 (first procedure, mm + SD) |
18.4 + 4.5 |
|
Line 3 (repeat procedure, mm + SD) |
28.6 + 6.5 |
|
Delta line 3 (mm + SD) |
10.2 + 6.6 |
|
Overall lesion regression (mm + SD) |
11.2 + 3.2 |