Ostial Dimensional Changes After Pulmonary Vein Isolation: Pulsed Field Ablation vs Radiofrequency Ablation.

ABSTRACT Background Pulmonary vein (PV) stenosis is an important potential complication of PV isolation using thermal modalities such as radiofrequency ablation (RFA). Pulsed field ablation (PFA) is an alternative energy that causes non-thermal myocardial cell death. Objective To compare the impact of PFA vs RFA on the incidence and severity of PV narrowing or stenosis. Methods Data were analyzed from 4 paroxysmal atrial fibrillation ablation trials employing either PFA or RFA; because of absent or poor CT quality, 73 of 153 patients were excluded. Baseline and 3-month cardiac CT scans were reconstructed into 3-dimensional images, and the long and short axes of the PV ostia were quantitatively and qualitatively assessed in a randomized, blinded manner by 2 physicians. Results A total of 299 PVs from 80 patients after either PFA (n=37) or RFA (n=43) were enrolled. PV ostial diameters decreased significantly less with PFA than RFA (% change; long axis, +0.9±8.5 vs -11.9±16.3, p Conclusions This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA.