Acute lesion extension following pulmonary vein isolation with two novel single shot devices: Pulsed field ablation versus multielectrode radiofrequency balloon

• Published in: Journal of cardiovascular electrophysiology 2023-09, Vol.34 (9), p.1802-1807
• Main Authors: My, Ilaria, Lemoine, Marc D, Butt, Mahi, Mencke, Celine, Loeck, Fabian W, Obergassel, Julius, Rottner, Laura, Wenzel, Jan-Per, Schleberger, Ruben, Moser, Julia, Moser, Fabian, Kirchhof, Paulus, Reissmann, Bruno, Ouyang, Feifan, Rillig, Andreas, Metzner, Andreas
• Format: Article
• Language: English
• Subjects: Ablation; Lesions; Lungs; Troponin I
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16001

Pulsed-field ablation (PFA) and the multielectrode radiofrequency balloon (RFB) are two novel ablation technologies to perform pulmonary vein isolation (PVI). It is currently unknown whether these technologies differ in lesion formation and lesion extent. We compared the acute lesion extent after PVI induced by PFA and RFB by measuring low-voltage area in high-density maps and the release of biomolecules reflecting cardiac injury. PVI was performed with a pentaspline catheter (FARAPULSE) applying PFA or with the compliant multielectrode RFB (HELIOSTAR). Before and after PVI high-density mapping with CARTO 3 was performed. In addition, blood samples were taken before transseptal puncture and after post-PVI remapping and serum concentrations of high-sensitive Troponin I were quantified by immunoassay. Sixty patients undergoing PVI by PFA (n = 28, age 69 ± 12 year, 60% males, 39.3% persistent atrial fibrillation [AF]) or RFB (n = 32, age 65 ± 13 year, 53% males, 21.9% persistent AF) were evaluated. Acute PVI was achieved in all patients in both groups. Mean number of PFA pulses was 34.2 ± 4.5 and mean number RFB applications was 8.5 ± 3 per patient. Total posterior ablation area was significantly larger in PFA (20.7 ± 7.7 cm²) than in RFB (7.1 ± 2.09 cm²; p