Does Pulsed Field Ablation Regress Over Time? A Quantitative Temporal Analysis of Pulmonary Vein Isolation

ABSTRACT Background The tissue specificity of pulsed field ablation (PFA) makes it an attractive energy source for pulmonary vein isolation (PVI). However, beyond each PFA lesion’s zone of irreversible electroporation and cell death, there may be a surrounding zone of reversible electroporation and cell injury that could potentially normalize with time. Objective To assess whether the level of electrical PVI that is observed acutely after PFA regresses over time. Methods In a clinical trial, paroxysmal atrial fibrillation patients underwent PVI using a biphasic PFA waveform delivered through a dedicated, variably-deployable multielectrode basket/flower catheter. Detailed voltage maps were created using a multispline diagnostic catheter immediately after PFA and again ∼3 months later in a prospective, protocol-specified reassessment procedure. We analyzed 20 PFA patients with durable PVI and available maps from both timepoints. To compare the ablated zones, the left- and right-sided PV antral isolation areas and nonablated posterior wall area were quantified, and the distances between left and right PV low voltage edges were measured. Results A comparison of voltage maps immediately after PFA and at a median of 84 (IQR:69-90) days later revealed that there was no significant difference in either the left- and right-sided PV antral isolation areas or nonablated posterior wall areas. The distances between low voltage edges on the posterior wall were also not significantly different between the 2 timepoints. Conclusions This study demonstrates that the level of PV antral isolation after PFA with a multielectrode PFA catheter persists without regression.