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Published on: May 26, 2015
Lesion formation following pulsed field ablation for pulmonary vein and posterior wall isolation
Christian Sohns1, Thomas Fink1, Martin Braun1
1Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Background:
Pulsed field ablation (PFA) results in unique lesion formation, but there is lack of in-vivo validation in terms of scar formation following atrial fibrillation (AF) ablation.
Objective:
We aimed to access atrial lesion formation based on late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) following PFA for pulmonary vein (PV) and posterior wall isolation (PWI).
Methods:
AF ablation was performed in 10 patients using a 31 mm pentaspline PFA catheter. After pulmonary vein isolation (PVI; n = 8 PFA-applications/ PV; n = 4 in basket and n = 4 in flower configuration), another eight applications in flower configuration were conducted for concomitant PWI. Patients underwent LGE CMR 3 months after ablation aiming for quantification of left atrial (LA) scar.
Results:
Acute procedural success was achieved in all patients. Mean procedure duration was 62 ± 7 min. and mean LA dwell time of the PFA catheter was 13 ± 2 min. Mean post ablation total LA scar burden was 8.1 ± 2.1% and mean scar width was 12.8 ± 2.1 mm. At the posterior LA, 22.6 ± 2.2% of the anatomical segment resulted in chronic scar tissue, concentrated at the PW. Postablation CMR found no evidence for PV stenosis or collateral damage of adjacent structures. At 7 months of follow-up, 9/10 patients (90%) were free from arrhythmia recurrence.
Conclusion:
PFA for AF resulted in durable and transmural atrial scar tissue at the PVs and PW. LGE CMR found a very homogeneous and contiguous lesion pattern with no signs for collateral damage.
