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Lessons learned from the first in human sequential colocalized PFA and RF lesions.

Daniel Alyesh1, Nicholas Palmeri2, Sri Sundaram2

  • 1South Denver Cardiology, 1000 South Park Drive, Littleton, CO, 80120, USA. Daniel.alyesh@gmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
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PubMed
Summary

Pulsed field ablation (PFA) improves atrial fibrillation treatment safety. Combining PFA with radiofrequency (RF) ablation may enable deeper, safer lesions in complex cardiac tissue, overcoming limitations of early PFA methods.

Keywords:
Atrial fibrillationMitral flutterPulsed field ablationRadiofrequency

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Area of Science:

  • Cardiovascular Medicine
  • Electrophysiology
  • Medical Devices

Background:

  • Pulsed field ablation (PFA) offers enhanced safety for atrial fibrillation treatment.
  • First-generation PFA has limitations in ablating heterogeneous cardiac tissue beyond pulmonary veins due to fixed electrical field parameters.
  • Radiofrequency (RF) ablation provides deeper lesion penetration but carries higher risks.

Purpose of the Study:

  • To evaluate the feasibility and safety of sequential, colocalized PFA and RF ablation.
  • To assess the potential of combining PFA and RF ablation for treating complex atrial fibrillation substrates.
  • To report the first human experience using a novel dual energy catheter for sequential ablation.

Main Methods:

  • Utilized an investigational 3.5-mm dual energy catheter.
  • Performed sequential, colocalized pulsed field ablation and radiofrequency ablation lesions in human subjects.
  • Focused on challenging substrates with heterogeneous tissue thickness.

Main Results:

  • Successfully delivered sequential colocalized PFA and RF lesions.
  • Demonstrated the potential for safe and deeper lesion creation in challenging cardiac substrates.
  • Marked the first human application of this combined ablation technique.

Conclusions:

  • Sequential colocalized PFA and RF ablation is feasible in humans.
  • This combined approach may overcome limitations of PFA alone for complex atrial fibrillation ablation.
  • Further investigation is warranted to establish the full clinical utility of this dual energy catheter system.