1 | INTRODUCTION
Thermal ablation, including radiofrequency (RFCA) and cryoablation, remains the conventional technique in the treatment of drug-refractory symptomatic atrial fibrillation (AF). Extensive ablation may cause adjacent tissue damage.1 For safety, reduced energy is usually required, with a compromise in lesion depth and durability. Pulsed field ablation (PFA) represents a novel nonthermal ablation approach using rapid electrical pulses to induce cardiac cell apoptosis via electroporation. PFA is characterized by high tissue selectivity that could potentially protect neighboring tissue from unintended injury.2-6 Recent works have demonstrated the feasibility and safety of PFA for pulmonary vein isolation (PVI) in paroxysmal AF.7,8 But the long-term efficacy and safety of PFA for persistent atrial fibrillation (PeAF) remain unknown.
PVI is considered the cornerstone for the treatment of PeAF.9 But PVI alone may be insufficient to maintain sinus rhythm in these patients. Linear ablation is one of the most common procedures used in addition to PVI. In our previous study, the ā€œ2C3Lā€ approach including bilateral PVI and three linear ablation lesion sets across the mitral isthmus (MI), left atrial (LA) roofline and cavotricuspid isthmus (CTI) is comparable to stepwise ablation in terms of arrhythmia-free survival.10 However, only limited studies have demonstrated the feasibility and safety of PFA for part linear ablation, such as MI block, left atrial posterior wall (LAPW) isolation, or CTI block, in addition to PVI in PeAF patients.11,12 Despite the clinical data was still insufficient, these preliminary findings bolster our confidence in advocating for the application of PFA in PeAF.
The present study aims to describe the feasibility and safety of PFA using the strategy including PVI, LAPW isolation, CTI block, and MI block in patients with PeAF.
2 | METHODS