Effect of Pulsed-Field Ablation on Human Coronary Arteries: A Longitudinal Study With Intracoronary Imaging.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-04-05 DOI:10.1016/j.jacep.2025.03.014

Mark T K Tam, Joseph Y S Chan, Chin Pang Chan, Eugene B Wu, Angel Lai, Alex C K Au, Wai Kin Chi, GuangMing Tan, Bryan P Yan

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引用次数: 0

Abstract

Background: Pulsed-field ablation (PFA) is known to cause acute coronary spasm. Whether this translates into long-term coronary artery stenosis is unknown.

Objectives: This study sought to evaluate changes in coronary artery after PFA for atrial flutter.

Methods: After pulmonary vein isolation with PFA (Farapulse; Boston Scientific), patients undergoing ablation of the mitral isthmus (MI) or cavotricuspid isthmus (CTI) were included. They underwent coronary angiography and optical coherence tomography (OCT) before and immediately after ablation. Bolus intracoronary nitroglycerine was given before and throughout ablation. Three months after ablation, patients underwent repeated OCT.

Results: A total of 21 patients were included. 1 patient did not undergo PFA owing to the incidental finding of a critical coronary lesion in close proximity to the area to be ablated. Another patient defaulted postprocedure imaging follow-up. 19 patients had paired imaging data, in 20 coronary vessels (18 right coronary and 2 left circumflex arteries). At the ablation site, at 3 months, vascular wall area increased by a median of 0.40 mm² (Q1-Q3: 0.13-0.71 mm²; P < 0.01), or 17.1% (Q1-Q3: 8.6%-31.0%). The median reduction in the luminal area was 0.70 mm² (Q1-Q3: 0.18-1.30 mm²; P < 0.01), or 10.1% (Q1-Q3: 4.7%-16.2%). These changes were not observed in a predetermined reference site remote from the ablation target.

Conclusions: PFA of the CTI and MI is associated with acute spasm, and mild narrowing of the coronary arteries at 3 months. Although intracoronary vasodilator therapy may prevent or treat acute spasm, the risk of arterial stenosis remains, calling for heightened vigilance and long-term follow-up.

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脉冲场消融对人冠状动脉的影响：冠状动脉内成像的纵向研究。

背景：已知脉冲场消融（PFA）可引起急性冠状动脉痉挛。这是否转化为长期冠状动脉狭窄尚不清楚。目的：本研究旨在评价心房扑动PFA后冠状动脉的变化。方法：PFA (Farapulse；波士顿科学研究)，包括接受二尖瓣峡（MI）或颈三尖瓣峡（CTI）消融的患者。消融前后均行冠状动脉造影和光学相干断层扫描（OCT）。消融前及消融过程中给予冠状动脉内灌注硝酸甘油。消融后3个月，再次行oct检查。结果：共纳入21例患者。1例患者未行PFA，因为偶然发现一个危急的冠状动脉病变靠近要消融的区域。另一名患者没有进行术后影像学随访。19例患者在20条冠状动脉（18条右冠状动脉和2条左旋动脉）中有配对成像数据。在消融部位，3个月时，血管壁面积中位数增加0.40 mm2 (Q1-Q3: 0.13-0.71 mm2；P < 0.01)，或17.1% （Q1-Q3: 8.6%-31.0%）。中位腔面积减少0.70 mm2 (Q1-Q3: 0.18-1.30 mm2；P < 0.01)，或10.1% （Q1-Q3: 4.7%-16.2%）。这些变化在远离消融目标的预定参考位置未被观察到。结论：CTI和MI的PFA与3个月时急性痉挛和轻度冠状动脉狭窄有关。尽管冠状动脉内血管扩张剂治疗可以预防或治疗急性痉挛，但动脉狭窄的风险仍然存在，需要提高警惕并长期随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.