Scholarlink

Background <p>Novel concepts for pulmonary vein isolation (PVI) like pulsed-field ablation (PFA) or high-power short-duration ablation (HPSD) promise favorable profiles of safety and efficacy. However, clinical comparisons of those novel concepts with conventional ablation approaches regarding ablation lesions are lacking. To systematically investigate lesion characteristics of novel ablation concepts, we performed a prospective head-to-head comparison using late gadolinium enhancement (LGE)-CMR.</p> Methods <p>This study included patients undergoing first-time PVI-only atrial fibrillation ablation—either by ablation index–guided radiofrequency ablation (RF), cryoballoon ablation (CRYO), HPSD (90W, 4&#xa0;s), or PFA (Farapulse). All patients received an LGE-CMR 3&#xa0;months post-ablation to assess ablation lesions.</p> Results <p>Post-ablation LGE-CMRs from 138 patients were analyzed (43 RF, 40 CRYO, 25 PFA, 30 HPSD). PFA resulted in the least continuous LGE lesion with the lowest proportion of complete PV-encircling LGE lesions (PFA 12%, HPSD 40%, RF 26%, CRYO 24%; <i>p</i> = 0.0069). Ablation with the CRYO and PFA single-shot devices resulted in the widest lesions. Of note, HPSD lesions were significantly wider than conventional RF lesions (PFA 12.7&#xa0;mm, HPSD 10.9&#xa0;mm, RF 8.7&#xa0;mm; CRYO 13.3&#xa0;mm; <i>p</i> &lt; 0.0001).</p> Conclusions <p>Lesion characteristics differed significantly among the four ablation techniques. HPSD ablation resulted in the most continuous LGE lesions. Of note, HPSD lesions were also wider than conventional RF lesions, thus corroborating the concept of a shallower HPSD lesion geometry from experimental studies. PFA lesions cover relatively large areas but are more inhomogeneous. Wether this indicates ineffective ablation or lower detectability of PFA lesions by LGE-CMR remains unknown.</p> Graphical Abstract <p>Ablation lesion characteristics differ significantly between ablation techniques, with high-power short-duration RF ablation (HPSD) resulting in the most continuous late gadolinium enhancement lesions in MRI.</p> <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Head-to-head comparison of pulsed-field ablation, high-power short-duration ablation, cryoballoon and conventional radiofrequency ablation by MRI-based ablation lesion assessment

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年6月24日

查看全文
  • Mariona Regany-Closa,
  • Josep Pomes-Perez,
  • Eric Invers-Rubio,
  • Roger Borras,
  • Berta Pellicer-Sendra,
  • Susanna Prat-Gonzalez,
  • Rosario Jesus Perea,
  • Carlos Igor Morr,
  • Jean-Baptiste Guichard,
  • Elena Arbelo,
  • Jose Maria Tolosana,
  • Eduard Guasch,
  • Andreu Porta-Sanchez,
  • Marta Sitges,
  • Josep Brugada,
  • Ivo Roca-Luque,
  • Lluís Mont,
  • Till F. Althoff

摘要

Background

Novel concepts for pulmonary vein isolation (PVI) like pulsed-field ablation (PFA) or high-power short-duration ablation (HPSD) promise favorable profiles of safety and efficacy. However, clinical comparisons of those novel concepts with conventional ablation approaches regarding ablation lesions are lacking. To systematically investigate lesion characteristics of novel ablation concepts, we performed a prospective head-to-head comparison using late gadolinium enhancement (LGE)-CMR.

Methods

This study included patients undergoing first-time PVI-only atrial fibrillation ablation—either by ablation index–guided radiofrequency ablation (RF), cryoballoon ablation (CRYO), HPSD (90W, 4 s), or PFA (Farapulse). All patients received an LGE-CMR 3 months post-ablation to assess ablation lesions.

Results

Post-ablation LGE-CMRs from 138 patients were analyzed (43 RF, 40 CRYO, 25 PFA, 30 HPSD). PFA resulted in the least continuous LGE lesion with the lowest proportion of complete PV-encircling LGE lesions (PFA 12%, HPSD 40%, RF 26%, CRYO 24%; p = 0.0069). Ablation with the CRYO and PFA single-shot devices resulted in the widest lesions. Of note, HPSD lesions were significantly wider than conventional RF lesions (PFA 12.7 mm, HPSD 10.9 mm, RF 8.7 mm; CRYO 13.3 mm; p < 0.0001).

Conclusions

Lesion characteristics differed significantly among the four ablation techniques. HPSD ablation resulted in the most continuous LGE lesions. Of note, HPSD lesions were also wider than conventional RF lesions, thus corroborating the concept of a shallower HPSD lesion geometry from experimental studies. PFA lesions cover relatively large areas but are more inhomogeneous. Wether this indicates ineffective ablation or lower detectability of PFA lesions by LGE-CMR remains unknown.

Graphical Abstract

Ablation lesion characteristics differ significantly between ablation techniques, with high-power short-duration RF ablation (HPSD) resulting in the most continuous late gadolinium enhancement lesions in MRI.