Co-Author(s):
Petr Neuzil, MD
Poojita Shivamurthy, MD
Kenji Kuroki, MD,PhD
Jeff Lam, MS
Daniel Masikantow, MD
Edward Chu, MD
Mohit Turagam, MD
Kentro Minami, MD
Moritoshi Funasako, MD,PhD
Jan Petru, MD
Aamir Sofi, MD
Subbarao Choudry, MD
Marc Miller, MD
Noelle Langan, MD
William Whang, MD
Jacob Koruth, MD
Srinivas Dukkipati, MD
Vivek Reddy, MD
Ichan School of Medicine at Mount Sinai
One Gustave L. Levy Place, Box 1030, New York, NY, USA, 10029
Introduction | Objectives: Catheter-based pulsed field ablation (PFA) is a novel non-thermal energy source for pulmonary vein isolation (PVI) with unique aspects including reduced dependence on tissue contact, and enhanced safety.  However its effect on the area of electrical PVI has not been described as compared to PVI using standard thermal ablation technologies.
Methods: In a clinical trial (NCT 03714178), paroxysmal atrial fibrillation (PAF) patients underwent PVI using an optimized biphasic waveform with a multielectrode pentaspline PFA catheter (Farapulse Inc).  After 75 days, detailed voltage maps were created during prospective, protocol-specified remapping studies.  In order to compare the area of PVI, we retrospectively collected consecutive PAF patients who i) underwent PVI using thermal energy, ii) underwent a redo procedure for recurrence, and iii) all PVs were durably isolated.  After detailed electroanatomical mapping with a high-density mapping catheter, the left and right PV antral isolation areas and nonablated posterior wall areas were quantified.
Results: We identified 20 patients with durable PVI in the PFA cohort, and 39 patients from the thermal ablation cohort (29 radiofrequency ablation, 6 cryoballoon and 4 visually-guided laser balloon).  PFA patients were younger and had shorter follow up compared to patients in the thermal  cohort.  Left atrial diameter and ventricular systolic function were preserved in both cohorts. There was no significant difference between the PFA and thermal ablation cohort in the left- and right-sided PV isolation areas, as well as nonablated posterior wall area.  The PFA cohort has smaller right superior PV isolation area compared to the radiofrequency ablation cohort, but this significance disappeared after propensity score matching.  Notch-like normal voltage areas was seen at the posterior side of the carina in the Balloon sub-cohort, but not the PFA or RFA cohorts.
Conclusions: Catheter-based PVI with the pentaspline PFA catheter creates a chronic PV antral isolation area as encompassing as thermal energy ablation.
AFS 2021-14