Pulmonary vein narrowing after voltage-guided adjunctive pulmonary vein sleeve pulsed field ablation

Pulsed field ablation (PFA) for pulmonary vein (PV) isolation (PVI) has been associated with a low risk of PV stenosis when performed using the standard ostial workflow. However, the risk of PV narrowing after adjunctive PV sleeve PFA remains insufficiently evaluated.

To assess PV narrowing after voltage-guided adjunctive PV sleeve PFA.

We retrospectively studied 147 patients who underwent an initial pentaspline PFA-based PVI for atrial fibrillation. In addition to standard ostial PVI, voltage-guided PFA applications were delivered to target PV sleeve potentials identified on pre-ablation voltage mapping. Contrast-enhanced computed tomography was performed before and approximately six months after ablation. PV cross-sectional areas (PVAs) were measured at predefined levels, and the maximum PVA reduction rate was defined as ΔPVA. Significant PV narrowing was defined as ΔPVA ≥25%.

Post-ablation PVA was significantly smaller than pre-ablation PVA at all PV sites. The median ΔPVA was 5.4%, 6.4%, 4.6%, and 4.0% in the left superior, left inferior, right superior, and right inferior PVs, respectively, and differed significantly among the four PV sites (P = 0.012). No significant PV narrowing was observed in this cohort.

In patients undergoing an initial PFA-based PVI, no significant PV narrowing was observed approximately six months after voltage-guided adjunctive PV sleeve PFA using a pentaspline catheter. Further controlled studies with larger populations and longer follow-up are needed to better characterize the safety and clinical utility of this strategy.