Pulsed field ablation for paroxysmal atrial fibrillation is safe for the esophagus

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Thermal LA ablation, like RF, cryo and laser can cause esophageal damage, like ulcera and atrio-esophageal fistula. Pulsed field ablation (PFA) is a novel, non-thermal ablation modality. Pre-clinical evaluation of PFA showed absence of thermal injury to the esophagus due to the tissue specificity of PFA. Only limited data from very small clinical studies on absence of esophageal injury after PFA is available. Objective We report on possible esophageal injury after PVI using PFA for paroxysmal AF in a real-world, non-clinical study setting. Methods A LA bipolar voltage 3D map was created. All PVs were individually isolated using a 13F steerable sheath and a pentaspline over-the-wire PFA catheter. After ablation, mapping was repeated to assess lesion formation. No proton-pump inhibitors were started. One day after PVI, esophagoscopy without biopsies was performed. All patients had a 30-day follow-up. Results In 30 patients (mean 63 years; 47% male), uncomplicated PFA was performed, with all PVs acutely isolated. Post ablation, all voltage maps consistently showed extensive antral PV lesions. Clinical course was uneventful, no patient had chest discomfort, coughing or hematemesis. All patients underwent uncomplicated esophagoscopy, without thermal lesions or ulcers. At 30-day follow-up, all patients were asymptomatic. Conclusion In a real-world, non-clinical study setting, PVI using PFA for paroxysmal AF is safe for the esophagus. Figures: Postero-anterior LA view before (above) and after (below) ablation with the esophaus (dark grey) projected over the posterior wall. The right bipolar voltage 3D map shows extensive, non-magenta antral ablation lesions.