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Ostial dimensional changes after pulmonary vein isolation: Pulsed field ablation vs radiofrequency ablation.

Abstract：

BACKGROUND:Pulmonary vein (PV) stenosis is an important potential complication of PV isolation using thermal modalities such as radiofrequency ablation (RFA). Pulsed field ablation (PFA) is an alternative energy that causes nonthermal myocardial cell death. OBJECTIVE:The purpose of this study was to compare the effect of PFA vs RFA on the incidence and severity of PV narrowing or stenosis. METHODS:Data were analyzed from 4 paroxysmal atrial fibrillation ablation trials using either PFA or RFA; because of absent CT scans or poor computed tomography scan quality, 73 of 153 patients (47.7%) were excluded. Baseline and 3-month cardiac computed tomography scans were reconstructed into 3-dimensional images, and the long and short axes of the PV ostia were quantitatively and qualitatively assessed in a randomized blinded manner by 2 physicians. RESULTS:A total of 299 PVs from 80 patients after either PFA (n = 37) or RFA (n = 43) were enrolled. PV ostial diameters decreased significantly less with PFA than with RFA (% change; long axis: 0.9% ± 8.5% vs -11.9% ± 16.3%; P < .001 and short axis: 3.4% ± 12.7% vs -12.9% ± 18.5%; P < .001). After a combined quantitative/qualitative analysis, mild (30%-49%), moderate (50%-69%), or severe (70%-100%) PV narrowing was observed, respectively, in 9.0% (15 of 166), 1.8% (3 of 166), and 1.2% (2 of 166) of PVs in the RFA cohort but in none of the PVs after PFA (P < .001). Overall, PV narrowing/stenosis was present in 0% and 0% vs 12.0% and 32.5% of PVs and patients who underwent PFA and RFA, respectively. CONCLUSION:This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Kuroki K,Whang W,Eggert C,Lam J,Leavitt J,Kawamura I,Reddy A,Morrow B,Schneider C,Petru J,Turagam MK,Koruth JS,Miller MA,Choudry S,Ellsworth B,Dukkipati SR,Neuzil P,Reddy VY

doi

10.1016/j.hrthm.2020.04.040

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

1528-1535

issue

9

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(20)30410-0

journal_volume

17

pub_type

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