AIMS: We studied the extent/area of electrical pulmonary vein isolation (PVI) after either pulsed field ablation (PFA) using a pentaspline catheter or thermal ablation technologies. METHODS AND RESULTS: In a clinical trial (NCT03714178), paroxysmal atrial fibrillation (PAF) patients underwent PVI with a multi-electrode pentaspline PFA catheter using a biphasic waveform, and after 75 days, detailed voltage maps were created during protocol-specified remapping studies. Comparative voltage mapping data were retrospectively collected from consecutive PAF patients who (i) underwent PVI using thermal energy, (ii) underwent reablation for recurrence, and (iii) had durably isolated PVs. The left and right PV antral isolation areas and non-ablated posterior wall were quantified. There were 20 patients with durable PVI in the PFA cohort, and 39 in the thermal ablation cohort [29 radiofrequency ablation (RFA), 6 cryoballoon, and 4 visually guided laser balloon]. Pulsed field ablation patients were younger with shorter follow-up. Left atrial diameter and ventricular systolic function were preserved in both cohorts. There was no significant difference between the PFA and thermal ablation cohorts in either the left- and right-sided PV isolation areas, or the non-ablated posterior wall area. The right superior PV isolation area was smaller with PFA than RFA, but this disappeared after propensity score matching. Notch-like normal voltage areas were seen at the posterior aspect of the carina in the balloon sub-cohort, but not the PFA or RFA cohorts. CONCLUSION: Catheter-based PVI with the pentaspline PFA catheter creates chronic PV antral isolation areas as encompassing as thermal energy ablation.

Department of Cardiology Na Homolka Hospital Prague Czech Republic

Helmsley Electrophysiology Center Department of Cardiology Icahn School of Medicine at Mount Sinai One Gustave L Levy Place Box 1030 New York NY 10029 USA

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Davalos RV, Mir LM, Rubinsky B.. Tissue ablation with irreversible electroporation. Ann Biomed Eng 2005;33:223–31. PubMed

Kotnik T, Kramar P, Pucihar G, Miklavčič D, Tarek M.. Cell membrane electroporation - Part 1: The phenomenon. IEEE Electr Insul Mag 2012;28:14–23.

Reddy VY, Koruth J, Jais P, Petru J, Timko F, Skalsky I. et al. Ablation of atrial fibrillation with pulsed electric fields: an ultra-rapid, tissue-selective modality for cardiac ablation. JACC Clin Electrophysiol 2018;4:987–95. PubMed

Koruth JS, Kuroki K, Iwasawa J, Viswanathan R, Buck ED, Donskoy E. et al. Endocardial ventricular pulsed field ablation : a proof-of-concept preclinical evaluation. Europace 2020;22:434–9. PubMed PMC

Koruth J, Kuroki K, Iwasawa J, Enomoto Y, Viswanathan R, Brose R. et al. Preclinical evaluation of pulsed field ablation: electrophysiological and histological assessment of thoracic vein isolation. Circ Arrhythm Electrophysiol 2019;12:e007781. PubMed PMC

Howard B, Haines DE, Verma A, Packer D, Kirchhof N, Barka N. et al. Reduction in pulmonary vein stenosis and collateral damage with pulsed field ablation compared to radiofrequency ablation in a canine model. Circ Arrhythm Electrophysiol 2020;13:e008337. PubMed PMC

Reddy VY, Neuzil P, Koruth JS, Petru J, Funosako M, Cochet H. et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol 2019;74:315–26. PubMed

Reddy VY, Dukkipati SR, Neuzil P, Pulsed field ablation of paroxysmal atrial fibrillation: one-year outcomes of IMPULSE, PEFCAT & PEFCAT II.JACC Clin Electrophysiol 2021. PubMed

Kiuchi K, Kircher S, Watanabe N, Gaspar T, Rolf S, Arya A. et al. Quantitative analysis of isolation area and rhythm outcome in patients with paroxysmal atrial fibrillation after circumferential pulmonary vein antrum isolation using the pace-and-ablate technique. Circ Arrhythm Electrophysiol 2012;5:667–75. PubMed

Reddy VY, Neuzil P, d’Avila A, Laragy M, Malchano ZJ, Kralovec S. et al. Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation? Heart Rhythm 2008;5:353–60. PubMed

Kenigsberg DN, Martin N, Lim HW, Kowalski M, Ellenbogen KA.. Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon. Heart Rhythm 2015;12:283–90. PubMed

Miyazaki S, Taniguchi H, Hachiya H, Nakamura H, Takagi T, Iwasawa J. et al. Quantitative analysis of the isolation area during the chronic phase after a 28-mm second-generation cryoballoon ablation demarcated by high-resolution electroanatomic mapping. Circ Arrhythmia Electrophysiol 2016;9:e003879. PubMed

Dukkipati SR, Cuoco F, Kutinsky I, Aryana A, Bahnson TD, Lakkireddy D. et al. Pulmonary vein isolation using the visually guided laser balloon a prospective, multicenter, and randomized comparison to standard radiofrequency ablation. J Am Coll Cardiol 2015;66:1350–60. PubMed

Anter E, Tschabrunn CM, Josephson ME.. High-resolution mapping of scar-related atrial arrhythmias using smaller electrodes with closer interelectrode spacing. Circ Arrhythm Electrophysiol 2015;8:537–45. PubMed

Loh P, Groen MHA, Neven K, Kassenberg W, Wittkampf FHM, Loh P.. Pulmonary vein isolation with single pulse irreversible electroporation : a first in human study in 10 patients with atrial fibrillation. Circ Arrhythm Electrophysiol 2020;13:e008192. PubMed

Ramirez FD, Reddy VY, Viswanathan R, Hocini M, Jaïs P.. Emerging technologies for pulmonary vein isolation. Circ Res 2020;127:170–83. PubMed

Nagashima K, Okumura Y, Watanabe I, Nakahara S, Hori Y, Iso K. et al. Hot balloon versus cryoballoon ablation for atrial fibrillation: lesion characteristics and middle-term outcomes. Circ Arrhythm Electrophysiol 2018;11:e005861. PubMed

Nanbu T, Yotsukura A, Suzuki G, Ishidoya Y, Sano F, Yoshida I. et al. Important factors in left atrial posterior wall isolation using 28-mm cryoballoon ablation for persistent atrial fibrillation—block line or isolation area? J Cardiovasc Electrophysiol 2020;31:119–27. PubMed

Reddy VY, Anic A, Koruth J, Petru J, Funasako M, Minami K. et al. Pulsed field ablation in patients with persistent atrial fibrillation. J Am Coll Cardiol 2020;76:1068–80. PubMed

Rodríguez-Mañero M, Valderrábano M, Baluja A, Kreidieh O, Martínez-Sande JL, García-Seara J. et al. Validating left atrial low voltage areas during atrial fibrillation and atrial flutter using multielectrode automated electroanatomic mapping. JACC Clin Electrophysiol 2018;4:1541–52. PubMed