Pulsed Field Ablation Shows Promise in Isolating Pulmonary Veins in AFib

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Pulsed field ablation (PFA) rapidly and efficiently isolated pulmonary veins "with a degree of tissue selectivity and a safety profile heretofore not described for cardiac ablation," said researchers presenting findings at the Heart Rhythm Scientific Sessions in San Francisco. The study, which was simultaneously published in the Journal of the American College of Cardiology, also suggests that PFA can achieve a high degree of durable pulmonary vein isolation.

Researchers, led by Vivek Y. Reddy, MD, conducted two trials to assess the safety and effectiveness of catheter-based PFA in 81 patients with paroxysmal atrial fibrillation. Pulmonary veins were acutely isolated by monophasic (n=15) or biphasic (n=66) PFA with ≤3 min elapsed delivery/patient, skin-to-skin procedure time of 92.2±27.4 min, and fluoroscopy time of 13.1±7.6 min.

Results found that durability at three months improved with successive waveform refinement from 18 percent to 100 percent of patients with all pulmonary veins isolated. Researchers noted that with the exception of one procedure-related pericardial tamponade, there were no additional primary adverse events over 120 days median follow-up, including: stroke, phrenic nerve injury, pulmonary vein stenosis and esophageal injury.

"PFA preferentially affected myocardial tissue, allowing facile ultra-rapid pulmonary vein isolation with excellent durability and chronic safety," said Reddy and colleagues. "Although this is only a two-center study of a relatively modest number of patients, the major safety and efficacy issues relevant to PFA have been addressed. It would be appropriate to now commence a larger multicenter study of PFA – preferably in comparison to standard thermal ablation.

Keywords: Pulmonary Veins, Atrial Fibrillation, Cardiac Tamponade, Phrenic Nerve, Catheter Ablation, Fluoroscopy, Stroke

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