Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-AB24 - Efficacy, Safety, and Potential Advantages of a New Energy Source for Catheter Ablation of Myocardial Tissue (ID 21) Abstract

D-AB24-06 - Esophageal Injury On Cardiac Magnetic Resonance After Catheter Ablation For Atrial Fibrillation: Comparison Between Pulsed Field, Cryoballoon And Radiofrequency Techniques (ID 1458)


Background: Esophageal injury can lead to dramatic complications after catheter ablation for atrial fibrillation. As opposed to thermal methods, non-thermal pulsed field ablation (PFA) has generated preclinical data to suggest that it may selectively spare the esophagus, although clinical confirmation is lacking.
Objective: To characterize esophageal injury on cardiac magnetic resonance (CMR) after PFA as compared to thermal ablation methods in pts undergoing pulmonary vein isolation (PVI).
Methods: CMR was performed before, acutely (<3h) and 3-month post-ablation in 41 patients with paroxysmal atrial fibrillation undergoing PVI with PFA (N=19, Farapulse®) or thermal methods (N=22, 15 RF, 7 cryo). Esophageal injury was assessed by late gadolinium enhanced (LGE) imaging.
Results: Baseline CMR showed no abnormality on the esophagus. Acutely, thermal methods induced high rates of lesions on the esophagus (45%). All of these lesions were observed in patients showing direct contact between the esophagus and the posterior left atrium exhibiting post-ablation LGE. By contrast, esophageal lesions were observed in none of the 19 patients ablated with PFA (0%, P<0.001 vs. thermal methods), despite similar rates of direct contact between the esophagus and the ablated posterior left atrium (P=0.80). CMR at 3 months showed a complete resolution of esophageal LGE in all patients. None of the patients showed clinical signs of atrioesophageal fistula.
Conclusion: As opposed to thermal methods, PFA does not induce any signs of esophageal injury on CMR after PVI. Due to its tissue selectivity, PFA may dramatically improve safety for catheter ablation of atrial fibrillation.