Comparative Efficacy and Safety of Pulsed Field Ablation Versus Radiofrequency Ablation of Idiopathic LV Arrhythmias

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Clinical electrophysiology Pub Date : 2024-09-01 DOI:10.1016/j.jacep.2024.04.025

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Abstract

Background

Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking.

Objectives

This study sough to compare RFA with PFA of common idiopathic LV-VAs locations.

Methods

Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach. Ablations were delivered using an investigational dual-energy (RFA/PFA) contact force (CF) and local impedance-sensing catheter. After 1-week survival, animals were euthanized for lesion assessment.

Results

A total of 55 PFA (4 applications/site of 2.0 KV, target CF ≥10 g) and 36 RFA (CF ≥10 g, 25–50 W targeting ≥50 Ω local impedance drop, 60-second duration) were performed. LV interventricular septum: average PFA depth 7.8 mm vs RFA 7.9 mm (P = 0.78) and no adverse events. Papillary muscle: average PFA depth 8.1 mm vs RFA 4.5 mm (P < 0.01). Left ventricular summit: average PFA depth 5.6 mm vs RFA 2.7 mm (P < 0.01). Steam-pop and/or ventricular fibrillation in 4 of 12 RFA vs 0 of 12 PFA (P < 0.01), no ST-segment changes observed. Epicardium: average PFA depth 6.4 mm vs RFA 3.3 mm (P < 0.01). Transient ST-segment elevations/depressions occurred in 4 of 5 swine in the PFA arm vs 0 of 5 in the RFA arm (P < 0.01). Angiography acutely and at 7 days showed normal coronaries in all cases.

Conclusions

In this swine study, compared with RFA, PFA of common idiopathic LV-VAs locations produced deeper lesions with fewer steam pops. However, PFA was associated with higher rates of transient ST-segment elevations and depressions with direct epicardium ablation.

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脉冲场消融与射频消融治疗特发性左心室心律失常的疗效和安全性比较

背景：目前尚缺乏射频消融（RFA）与脉冲场消融（PFA）对常见特发性左室心律失常（LV-VAs）部位的疗效和安全性的比较数据：本研究试图比较 RFA 与 PFA 对常见特发性左心室-VAs 位置的治疗效果：方法：10 头猪被随机分为 PFA 和 RFA 两种，PFA 用于 LV 室间隔、乳头肌、经远端冠状动脉窦的 LV 峰部，RFA 用于剑突下途径的 LV 心外膜。消融使用的是一种研究性双能量（RFA/PFA）接触力（CF）和局部阻抗感应导管。动物存活 1 周后，安乐死以评估病变：共进行了 55 次 PFA（4 次/部位，2.0 KV，目标 CF ≥10 g）和 36 次 RFA（CF ≥10 g，25-50 W，目标≥50 Ω局部阻抗下降，持续时间 60 秒）。左心室室间隔：PFA 平均深度为 7.8 毫米，RFA 为 7.9 毫米（P = 0.78），无不良反应。乳头肌：PFA 平均深度为 8.1 毫米，RFA 为 4.5 毫米（P < 0.01）。左心室顶点：平均 PFA 深度 5.6 毫米 vs RFA 2.7 毫米（P < 0.01）。12 例 RFA 中的 4 例与 12 例 PFA 中的 0 例相比（P < 0.01），未观察到 ST 段变化。心外膜：PFA 平均深度为 6.4 毫米，RFA 为 3.3 毫米（P < 0.01）。PFA 组 5 头猪中有 4 头出现短暂的 ST 段抬高/压低，而 RFA 组 5 头猪中只有 0 头出现这种情况（P < 0.01）。所有病例在急性期和 7 天后的血管造影均显示冠状动脉正常：结论：在这项猪研究中，与 RFA 相比，PFA 对常见的特发性左心室-VA 病变部位产生的病变更深，蒸汽爆裂更少。然而，与直接心外膜消融相比，PFA 与较高的一过性 ST 段抬高和压低相关。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.