Lesion Visualization of Pulsed Field Ablation by MRI in an Expanded Series of PAF PatientsPierre Jais1, MD, Yosuke Natakatani1, MD, Frederic Sacher1, MD, Nadir Tafer1, MD, M. Hocini1, MD PhD, M. Haissaguerre1, MD PhD, T. Pambrun1, MD, M. Takigawa1, MD PhD, Nicolas
Derval1, MD, Richard Brose2, MS, Eric Buck2, MS, Raju Viswanathan2, PhD, Hubert Cochet1, MD PhD1Le CHU de Bordeaux, Bordeaux Univ. & L’Institut de Rythmologie et Modéllation Cardiaque (LIRYC) IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030 Bordeaux, France,
2FARAPULSE, Inc.
INTRODUCTION• Non-thermal pulsed field ablation (PFA) is a modality that has
demonstrated myocardial specificity and may prevent extracardiac ablation• Late gadolinium-enhanced (LGE) MRI scans can provide direct visualization
of lesion extent, dimension and homogeneity• We report on an expanded series of LGE MRI scans taken within
immediately after PFA procedures.
Disclosures: PJ - Research Grant and Consultant. RB, RV, EB - Employee. YN, FS, NT, MHo, MHa, TP, MT, ND, HC - none.
METHODS• 23 patients (5 F, 56±11 y) with paroxysmal AF were included and received
CT or MRI scanning to gauge esophageal proximity• A five-spline 12F catheter inside a 13F deflectable sheath was positioned
for ostial pulmonary vein isolation using a dedicated PFA waveformgenerator (FARAPULSE)
• Measures to alter lesion placement based on the proximity of theesophagus and phrenic nerve were not taken
• Within 2 hours of PFA ablation, LGE MRI scans were performed tocharacterize the PFA lesions and assess for extracardiac damage.
RESULTS• 90/90 PVs, including left common PVs, were isolated following the ablation procedure• The average dwell time in the left atrium was 49.9±15.0 min, improving to 37.5±9.5 min in the most recent ten
procedures• Total energy delivery time per patient was less than 60 seconds• LGE MRI was performed on 18 patients after the procedure• The shortest LA-esophagus distance was noted next to the inferior veins: LIPV (12), RIPV (4), and rarely to the
LSPV (2)
CONCLUSIONSPFA creates dense and homogeneous lesions around the PVs, with no involvement of the esophagus asdemonstrated by acute LGE MRI in an expanded study of 18 patients.
PRE-ABLATION CT Distance to Eso (mm)
• In 17 patients, the esophagus was directly adjacent to PFA lesions, measuring from 0.5 to 2 mm (1.2±0.5 mm)• No esophageal lesion was present in any patient• No visible discontinuities suggestive of lesion heterogeneity were observed in any PV• Myocardial lesions were present in the area of the phrenic nerve in all RPVs but no clinical effects were seen
despite consistent phrenic capture during deliveries.
POST-ABLATION LGE POST-ABLATION LGE
Transverse Sagittal
Spared Esophagus
Eso
LA