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
ā2C3Lā 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