Pulmonary vein narrowing after pulsed field versus thermal ablation
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology..
AIMS: When it occurs, pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is associated with significant morbidity. Even mild-to-moderate PV narrowing may have long-term implications. Unlike thermal ablation energies, such as radiofrequency (RF) or cryothermy, pulsed field ablation (PFA) is a non-thermal modality associated with less fibrotic proliferation. Herein, we compared the effects of PFA vs. thermal ablation on PV narrowing after AF ablation.
METHODS AND RESULTS: ADVENT was a multi-centre, randomized, single-blind study comparing PFA (pentaspline catheter) with thermal ablation-force-sensing RF or cryoballoon (CB)-to treat drug-refractory paroxysmal AF. Pulmonary vein diameter and aggregate cross-sectional area were obtained by baseline and 3-month imaging. The pre-specified, formally tested, secondary safety endpoint compared a measure of PV narrowing between PFA vs. thermal groups, with superiority defined by posterior probability > 0.975. Among subjects randomized to PFA (n = 305) or thermal ablation (n = 302), 259 PFA and 255 thermal ablation (137 RF and 118 CB) subjects had complete baseline and 3-month PV imaging. No subject had significant (≥70%) PV stenosis. Change in aggregate PV cross-sectional area was less with PFA (-0.9%) than thermal ablation (-12%, posterior probability > 0.999)-primarily driven by the RF sub-cohort (-19.5%) vs. CB sub-cohort (-3.3%). Almost half of all PFA PV diameters did not decrease, but the majority (80%) of RF PVs decreased, regardless of PV anatomic location.
CONCLUSION: In this first randomized comparison of PFA vs. thermal ablation, PFA resulted in less PV narrowing-thereby underscoring the qualitatively differential and favourable impact of PFA on PV tissue.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology - 26(2024), 2 vom: 01. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mansour, Moussa [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial fibrillation |
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| Anmerkungen: |
Date Completed 20.02.2024 Date Revised 21.02.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/europace/euae038 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Pulmonary vein narrowing after pulsed field versus thermal ablation |
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| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. | ||
| 520 | |a AIMS: When it occurs, pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is associated with significant morbidity. Even mild-to-moderate PV narrowing may have long-term implications. Unlike thermal ablation energies, such as radiofrequency (RF) or cryothermy, pulsed field ablation (PFA) is a non-thermal modality associated with less fibrotic proliferation. Herein, we compared the effects of PFA vs. thermal ablation on PV narrowing after AF ablation | ||
| 520 | |a METHODS AND RESULTS: ADVENT was a multi-centre, randomized, single-blind study comparing PFA (pentaspline catheter) with thermal ablation-force-sensing RF or cryoballoon (CB)-to treat drug-refractory paroxysmal AF. Pulmonary vein diameter and aggregate cross-sectional area were obtained by baseline and 3-month imaging. The pre-specified, formally tested, secondary safety endpoint compared a measure of PV narrowing between PFA vs. thermal groups, with superiority defined by posterior probability > 0.975. Among subjects randomized to PFA (n = 305) or thermal ablation (n = 302), 259 PFA and 255 thermal ablation (137 RF and 118 CB) subjects had complete baseline and 3-month PV imaging. No subject had significant (≥70%) PV stenosis. Change in aggregate PV cross-sectional area was less with PFA (-0.9%) than thermal ablation (-12%, posterior probability > 0.999)-primarily driven by the RF sub-cohort (-19.5%) vs. CB sub-cohort (-3.3%). Almost half of all PFA PV diameters did not decrease, but the majority (80%) of RF PVs decreased, regardless of PV anatomic location | ||
| 520 | |a CONCLUSION: In this first randomized comparison of PFA vs. thermal ablation, PFA resulted in less PV narrowing-thereby underscoring the qualitatively differential and favourable impact of PFA on PV tissue | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Pulmonary vein stenosis | |
| 650 | 4 | |a Pulsed field ablation | |
| 650 | 4 | |a Randomized controlled trial | |
| 700 | 1 | |a Gerstenfeld, Edward P |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Chinmay |e verfasserin |4 aut | |
| 700 | 1 | |a Natale, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Whang, William |e verfasserin |4 aut | |
| 700 | 1 | |a Cuoco, Frank A |e verfasserin |4 aut | |
| 700 | 1 | |a Mountantonakis, Stavros E |e verfasserin |4 aut | |
| 700 | 1 | |a Gibson, Douglas N |e verfasserin |4 aut | |
| 700 | 1 | |a Harding, John D |e verfasserin |4 aut | |
| 700 | 1 | |a Holland, Scott K |e verfasserin |4 aut | |
| 700 | 1 | |a Achyutha, Anitha B |e verfasserin |4 aut | |
| 700 | 1 | |a Schneider, Christopher W |e verfasserin |4 aut | |
| 700 | 1 | |a Mugglin, Andrew S |e verfasserin |4 aut | |
| 700 | 1 | |a Albrecht, Elizabeth M |e verfasserin |4 aut | |
| 700 | 1 | |a Stein, Kenneth M |e verfasserin |4 aut | |
| 700 | 1 | |a Lehmann, John W |e verfasserin |4 aut | |
| 700 | 1 | |a Reddy, Vivek Y |e verfasserin |4 aut | |
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