Temporal Changes in LGE-CMR Enhancement After Monopolar Biphasic Focal Pulsed Field Ablation for Pulmonary Vein Isolation
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Published on: May 26, 2015
Maximilian Moersdorf1, Mathias Forkmann2, Michel Abou-Khalil3
1Department of Electrophysiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany; Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Tulane University, School of Medicine, New Orleans, USA.
Background:
Pulsed field ablation (PFA) has emerged as a novel non-thermal ablation modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). While chronic lesion formation after PFA has been described, data regarding acute lesion characteristics and lesion maturation remain limited.
Objective:
To characterize acute and chronic lesion formation following focal point-by-point PFA for PVI using serial late-gadolinium-enhancement cardiovascular-magnetic-resonance-imaging (LGE-CMR).
Methods:
Six consecutive patients with symptomatic paroxysmal or persistent AF underwent index PFA-guided PVI using the CENTAURI system and a focal point-by-point lesion delivery strategy. LGE-CMR was performed 1 day and 90±10 days after ablation. Quantitative assessment of regional and global left atrial (LA) enhancement was performed using a standardized segmentation protocol. Changes in enhancement burden and LA dimensions were analyzed between imaging timepoints.
Results:
Among six patients at mean age 65±7 years, five patients (83%) had paroxysmal AF. Acute PVI was achieved in all patients without procedural complications. Serial LGE-CMR demonstrated substantial temporal changes between acute and chronic imaging. Enhancement within the right pulmonary vein (PV) region decreased from 3.3±2.2% to 0.8±0.8%(p=0.030), while the proportion of enhanced tissue decreased from 24.1±13.5% to 5.7±5.8%(p=0.017). Similar reductions were observed around the left PVs (4.4±3.1%vs.1.4±1.2%, p=0.064). Posterior wall enhancement decreased from 2.4±1.1% to 0.3±0.3%(p=0.007) and global LA enhancement from 12.8±6.2% to 3.3±1.6%(p=0.013), while LA volume remained unchanged.
Conclusion:
Serial LGE-CMR demonstrated substantial enhancement reduction of acute lesions following focal point-by-point PFA for PVI, which remained largely confined to the PV antra and adjacent posterior wall, providing novel in-human insights into lesion maturation following focal PFA delivery.
