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Shen C, Jia Z, Yu Y, Feng M, Du X, Fu G, Yu L, Wu T, Jiang Y, Jin H, Zhuo W, Gao F, Wang B, Chen S, Dai J, Fang R, Chu H. Efficacy and safety of pulsed field ablation for accessory pathways: a pilot study. Europace 2024; 26:euae139. [PMID: 38801673 PMCID: PMC11218562 DOI: 10.1093/europace/euae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/06/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
AIMS Radiofrequency ablation is used as a first-line therapy for accessory pathways (APs). However, data regarding the effects of pulsed field ablation (PFA) on APs are limited. We sought to evaluate the acute procedural and 6-month success and safety of PFA in a cohort of patients with APs. METHODS AND RESULTS A focal contact force-sensing PFA catheter was used for patients with APs. Pulsed field ablation generator generated a bipolar and biphasic waveform (±1000 V) with a duration of 100 ms from the tip of the PFA catheter. A 100% acute procedural success was achieved in 10 conscious patients with APs (7 left anterolateral, 2 left inferolateral, and 1 right posteroseptal APs) including 6 (60%) patients after an initial application. The average total ablation time was 6.3 ± 4.9 s for 4.7 ± 1.8 ablation sites (ASs), including 3.1 ± 2.4 s at targets and 3.2 ± 2.9 s at 3.2 ± 2 bolus ASs. The mean skin-to-skin time was 59.3 ± 15.5 min, and PFA catheter dwell time was 29.4 ± 7.8 min. One patient encountered transient sinus arrest during PFA due to parasympathetic overexcitation. Sinus rhythm was restored in all patients without any significant adverse events during the short-term follow-up. CONCLUSION Pulsed field ablation of APs was feasible, effective, and safe. Its efficiency was remarkable for its ultrarapid termination of AP conduction. Further studies are warranted to prove whether utilization of PFA with current parameters can extend to manifold AP ablation.
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Affiliation(s)
- Caijie Shen
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Zhenyu Jia
- Health Science Center, Ningbo University, Ningbo 315000, China
| | - Yibo Yu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Mingjun Feng
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Xianfeng Du
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Guohua Fu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Lipu Yu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Tao Wu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Yongxing Jiang
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - He Jin
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Weidong Zhuo
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Fang Gao
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Binhao Wang
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Si Chen
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Jiating Dai
- Health Science Center, Ningbo University, Ningbo 315000, China
| | - Renyuan Fang
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Huimin Chu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
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Omotoye S, Singleton MJ, Zagrodzky J, Clark B, Sharma D, Metzl MD, Gallagher MM, Meininghaus DG, Leung L, Garg J, Warrier N, Panico A, Tamirisa K, Sanchez J, Mickelsen S, Sardana M, Shah D, Athill C, Hayat J, Silva R, Clark AT, Gray M, Levi B, Kulstad E, Girouard S, Zagrodzky W, Montoya MM, Bustamante TG, Berjano E, González-Suárez A, Daniels J. Mechanisms of action behind the protective effects of proactive esophageal cooling during radiofrequency catheter ablation in the left atrium. Heart Rhythm O2 2024; 5:403-416. [PMID: 38984358 PMCID: PMC11228283 DOI: 10.1016/j.hroo.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Proactive esophageal cooling for the purpose of reducing the likelihood of ablation-related esophageal injury resulting from radiofrequency (RF) cardiac ablation procedures is increasingly being used and has been Food and Drug Administration cleared as a protective strategy during left atrial RF ablation for the treatment of atrial fibrillation. In this review, we examine the evidence supporting the use of proactive esophageal cooling and the potential mechanisms of action that reduce the likelihood of atrioesophageal fistula (AEF) formation. Although the pathophysiology behind AEF formation after thermal injury from RF ablation is not well studied, a robust literature on fistula formation in other conditions (eg, Crohn disease, cancer, and trauma) exists and the relationship to AEF formation is investigated in this review. Likewise, we examine the abundant data in the surgical literature on burn and thermal injury progression as well as the acute and chronic mitigating effects of cooling. We discuss the relationship of these data and maladaptive healing mechanisms to the well-recognized postablation pathophysiological effects after RF ablation. Finally, we review additional important considerations such as patient selection, clinical workflow, and implementation strategies for proactive esophageal cooling.
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Affiliation(s)
| | | | - Jason Zagrodzky
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | | | | | - Mark D. Metzl
- NorthShore University Health System, Evanston, Illinois
| | - Mark M. Gallagher
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Lisa Leung
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jalaj Garg
- Loma Linda University Medical Center, Loma Linda, California
| | - Nikhil Warrier
- MemorialCare Heart & Vascular Institute, Fountain Valley, California
| | | | - Kamala Tamirisa
- Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, Dallas, Texas
| | - Javier Sanchez
- Cardiac Electrophysiology, Texas Cardiac Arrhythmia Institute, Dallas, Texas
| | | | | | - Dipak Shah
- Ascension Providence Hospital, Detroit, Michigan
| | | | - Jamal Hayat
- Department of Gastroenterology, St George’s University Hospital, London, United Kingdom
| | - Rogelio Silva
- Department of Medicine, Division of Gastroenterology, University of Illinois at Chicago, Chicago, Illinois
- Advocate Aurora Christ Medical Center, Chicago, Illinois
| | - Audra T. Clark
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Benjamin Levi
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | - Enrique Berjano
- Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana González-Suárez
- Translational Medical Device Lab, School of Medicine, University of Galway, Galway, Ireland
- Valencian International University, Valencia, Spain
| | - James Daniels
- University of Texas Southwestern Medical Center, Dallas, Texas
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3
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Rudolph I, Mastella G, Bernlochner I, Steger A, von Olshausen G, Hahn F, Wakili R, Laugwitz KL, Martens E, Rattka M. Efficacy and safety of pulsed field ablation compared to cryoballoon ablation in the treatment of atrial fibrillation: a meta-analysis. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae044. [PMID: 38933428 PMCID: PMC11200106 DOI: 10.1093/ehjopen/oeae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/04/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024]
Abstract
Aims Pulmonary vein isolation (PVI) represents the gold standard in the treatment of atrial fibrillation (AF) and the use of single-shot techniques, such as cryoballoon ablation (CBA) and pulsed field ablation (PFA) using a pentaspline catheter, has gained prominence. Recent studies hypothesize that PFA might be superior to CBA, although procedural efficacy and safety data are inconsistent. A meta-analysis was conducted to compare both energy sources for the treatment of AF. Methods and results A structured systematic database search and meta-analysis were performed on studies investigating outcomes, periprocedural complications, and/or procedural parameters of AF patients treated by either CBA or PFA. Eleven studies reporting data from 3805 patients were included. Pulmonary vein isolation by PFA was associated with a significantly lower recurrence of atrial fibrillation/atrial tachycardia [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.54-0.98, I2 = 20%] and fewer periprocedural complications (OR = 0.62, 95% CI = 0.40-0.96, I2 = 6%) compared to CBA. The lower complication rate following PFA was mainly driven by fewer phrenic nerve injuries (OR = 0.19, 95% CI = 0.08-0.43, I2 = 0%). However, there were more cases of cardiac tamponades after PFA (OR = 2.56, 95% CI = 1.01-6.49, I2 = 0%). Additionally, using PFA for PVI was associated with shorter total procedure times [mean difference (MD) = -9.68, 95% CI = -14.92 to -4.43 min, I2 = 92%] and lower radiation exposure (MD = -148.07, 95% CI = -276.50 to -19.64 µGy·mI2 = 7%). Conclusion Our results suggest that PFA for PVI, compared to CBA, enables shorter procedure times with lower arrhythmia recurrence and a reduced risk of periprocedural complications. Randomized controlled trials need to confirm our findings.
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Affiliation(s)
- Isabel Rudolph
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Giulio Mastella
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Isabell Bernlochner
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Alexander Steger
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Gesa von Olshausen
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Franziska Hahn
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Reza Wakili
- Department of Medicine and Cardiology, Goethe University, Frankfurt, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Rhine-Main, Germany
| | - Karl-Ludwig Laugwitz
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Eimo Martens
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
- European Reference Network Guard Heart, European Union
| | - Manuel Rattka
- School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
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4
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Farnir FIP, Luermans JGLM, Farnir FPFJDJ, Chaldoupi SM, Linz D. Impedance drop during focal monopolar pulsed field ablation in the atrium. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01793-z. [PMID: 38499824 DOI: 10.1007/s10840-024-01793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Florent I P Farnir
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Maastricht Heart+Vascular Center, Maastricht UMC+, 6202 AZ, Maastricht, the Netherlands.
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Grosse Meininghaus D, Freund R, Koerber B, Kleemann T, Matthes H, Geller JC. Pulsed-field ablation does not induce esophageal and periesophageal injury-A new esophageal safety paradigm in catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:86-93. [PMID: 37975544 DOI: 10.1111/jce.16132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Esophageal injury is one of the most serious complications of pulmonary vein isolation (PVI) with thermic energy sources. Better tissue selectivity of primarily non-thermic pulsed field ablation (PFA) may eliminate collateral injury, particularly the risk of atrio-esophageal fistula (AEF). OBJECTIVE To compare the incidence of any (peri)-esophageal injury following PVI using PFA to thermic energy sources. METHODS Using endoscopy, endoscopic ultrasound, and electrogastrography before and after PVI, esophageal and periesophageal injury (mucosal lesions, food retention, periesophageal edema, or vagal nerve injury) were assessed following PFA and radiofrequency (RF)- or cryoballoon (CB)-PVI. RESULTS Between December 2022 and February 2023, 20 patients (67 ± 10 years, 53% male) undergoing PFA (Farapulse, Boston Scientific) for atrial fibrillation (AF) were studied and compared with a previous cohort of 57 patients who underwent thermic PVI (CB: n = 33; RF: n = 24). Following PFA-PVI, none of the patients had mucosal lesions, food retention, or ablation-induced vagal nerve injury; four patients showed periesophageal edema. Following thermic ablation, 33/57 patients (58%) showed esophageal and/or periesophageal injury (CB: 21/33 [64%], RF: 12/24 [50%]), in detail 4/57 mucosal lesions, 18/57 food retention, 17/57 vagal nerve injury, and 20/52 edema. Midterm success rates were similar for all energy sources. CONCLUSION In contrast to thermic ablation tools, PFA is not associated with relevant esophageal and periesophageal injury, and might, therefore, reduce or eliminate the risk of potentially lethal AEF in interventional treatment of AF. The etiology of ablation-induced periesophageal edema is unknown but has not been shown to be related to lesion progression.
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Affiliation(s)
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Britta Koerber
- Division of Cardiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Tobias Kleemann
- Division of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Harald Matthes
- Division of Gastroenterology, Community-Hospital Havelhoehe Berlin, Berlin, Germany
| | - Johann Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
- Otto-von-Guericke University School of Medicine Magdeburg, Magdeburg, Germany
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Cvetkoska A, Maček-Lebar A, Polajžer T, Reberšek M, Upchurch W, Iaizzo PA, Sigg DC, Miklavčič D. The Effects of Interphase and Interpulse Delays and Pulse Widths on Induced Muscle Contractions, Pain and Therapeutic Efficacy in Electroporation-Based Therapies. J Cardiovasc Dev Dis 2023; 10:490. [PMID: 38132658 PMCID: PMC10744272 DOI: 10.3390/jcdd10120490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Electroporation is used in medicine for drug and gene delivery, and as a nonthermal ablation method in tumor treatment and cardiac ablation. Electroporation involves delivering high-voltage electric pulses to target tissue; however, this can cause effects beyond the intended target tissue like nerve stimulation, muscle contractions and pain, requiring use of sedatives or anesthetics. It was previously shown that adjusting pulse parameters may mitigate some of these effects, but not how these adjustments would affect electroporation's efficacy. We investigated the effect of varying pulse parameters such as interphase and interpulse delay while keeping the duration and number of pulses constant on nerve stimulation, muscle contraction and assessing pain and electroporation efficacy, conducting experiments on human volunteers, tissue samples and cell lines in vitro. Our results show that using specific pulse parameters, particularly short high-frequency biphasic pulses with short interphase and long interpulse delays, reduces muscle contractions and pain sensations in healthy individuals. Higher stimulation thresholds were also observed in experiments on isolated swine phrenic nerves and human esophagus tissues. However, changes in the interphase and interpulse delays did not affect the cell permeability and survival, suggesting that modifying the pulse parameters could minimize adverse effects while preserving therapeutic goals in electroporation.
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Affiliation(s)
- Aleksandra Cvetkoska
- Faculty of Electrical Engineering, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.C.); (A.M.-L.); (T.P.); (M.R.)
| | - Alenka Maček-Lebar
- Faculty of Electrical Engineering, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.C.); (A.M.-L.); (T.P.); (M.R.)
| | - Tamara Polajžer
- Faculty of Electrical Engineering, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.C.); (A.M.-L.); (T.P.); (M.R.)
| | - Matej Reberšek
- Faculty of Electrical Engineering, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.C.); (A.M.-L.); (T.P.); (M.R.)
| | - Weston Upchurch
- Visible Heart® Laboratories, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (W.U.); (P.A.I.)
| | - Paul A. Iaizzo
- Visible Heart® Laboratories, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (W.U.); (P.A.I.)
| | - Daniel C. Sigg
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN 55432, USA;
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.C.); (A.M.-L.); (T.P.); (M.R.)
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Yang M, Wang PY, Hao YL, Liang M, Yu ZY, Li XC, Li YP. A real-world case-control study on the efficacy and safety of pulsed field ablation for atrial fibrillation. Eur J Med Res 2023; 28:519. [PMID: 37968748 PMCID: PMC10648358 DOI: 10.1186/s40001-023-01509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/05/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE The primary objective of this study was to evaluate the efficacy and safety of pulsed field ablation in individuals diagnosed with atrial fibrillation. METHODS A total of 36 patients diagnosed with atrial fibrillation were enrolled in the pulsed field ablation group, while another 36 patients diagnosed with atrial fibrillation were included in the radiofrequency ablation group. Among the study participants, 15 patients in the pulsed field ablation group and 17 patients in the radiofrequency ablation group had persistent atrial fibrillation. Comprehensive comparisons were made between the two groups, including baseline data, underlying diseases, medication usage, intraoperative parameters, and atrial fibrillation recurrence rates at 1, 3, and 6 months during the postoperative follow-up period. RESULTS (1) There were no significant differences observed between the two groups concerning baseline data and antiarrhythmic drug usage (P > 0.05); (2) the effective ablation time for both left and right pulmonary veins in the pulsed field ablation group was markedly shorter compared to the radiofrequency ablation group (P < 0.001 for each vein); (3) within the pulsed field ablation group, the number of discharges, catheter operation time, and effective ablation time for the left pulmonary vein were significantly higher than those for the right pulmonary vein (P < 0.05). Conversely, in the radiofrequency ablation group, the number of discharges for the left pulmonary vein was significantly higher than that for the right pulmonary vein (P < 0.05); and (4) when comparing sinus rhythm maintenance at 1, 3, and 6 months postoperatively, no statistically significant differences were noted between the two groups for paroxysmal, persistent, and paroxysmal + persistent atrial fibrillation cases (P > 0.05). CONCLUSION During the 6-month follow-up period, pulsed field ablation demonstrated comparable efficacy to radiofrequency ablation with respect to recurrence rates for both paroxysmal and persistent atrial fibrillation. Moreover, pulsed field ablation exhibited high safety levels, excellent surgical efficiency, and a notably brief learning curve, affirming its viability as a therapeutic option for these conditions.
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Affiliation(s)
- Ming Yang
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, No.21 of Nieer Road, Hongta District, Yuxi, 653100, China.
| | - Peng-Yu Wang
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, No.21 of Nieer Road, Hongta District, Yuxi, 653100, China
| | - Ying-Lu Hao
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, No.21 of Nieer Road, Hongta District, Yuxi, 653100, China
| | - Mei Liang
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, No.21 of Nieer Road, Hongta District, Yuxi, 653100, China
| | - Zi-Yang Yu
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, No.21 of Nieer Road, Hongta District, Yuxi, 653100, China
| | - Xi-Chen Li
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, No.21 of Nieer Road, Hongta District, Yuxi, 653100, China
| | - Yan-Ping Li
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, No.21 of Nieer Road, Hongta District, Yuxi, 653100, China
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