New Orleans, United States — According to study results, the new electroporation ablation technique has been shown to be as safe and effective as standard thermal ablation techniques (radiofrequency or cryotherapy) in the treatment of atrial fibrillation (AF). PULLED AF presented at the Congress ofAmerican College of Cardiology (ACC 2023) [] 1]. Since this method can be carried out more quickly, it should be used with this indication without any problems.
“The effectiveness of the procedure is similar to thermal ablation, but the results are achieved faster and with greater certainty,” said the dr Atul Verma (Southlake Regional Health Centre, Toronto, Canada), lead author of the study. “This is a major breakthrough in electrophysiology,” he added. The results were published in Circulation[2].
The effectiveness of the procedure is similar to thermal ablation, but the results are achieved faster and with greater certainty.
Electroporation uses high-voltage electrical microshocks to open nanoscale pores in the membranes of targeted cardiac cells involved in cardiac arrhythmias, leading to their destruction. The technique has the advantage of not causing damage to non-cardiac collateral tissue, while current thermal ablation techniques can affect adjacent tissues, particularly the esophagus and phrenic nerve.
Radio frequency or cryotherapy ablation techniques are also complex procedures performed by a limited number of cardiologists. They require a procedure of two hours or more, while electroporation ablation can be performed in almost an hour, which could facilitate the use of AF ablation, which would become more generalized.
The prospective PULSED-AF study, conducted at 41 centers in nine countries, enrolled 300 patients with symptomatic paroxysmal (n=150) or persistent (n=150) atrial fibrillation who were receiving treatment with Class I or III -Antiarrhythmics had failed. They were all taken for electroporation ablation. The researchers say the procedure was completed in less than an hour.
The primary efficacy endpoint was a composite of absence of procedural failure, arrhythmia recurrence, reablation, need for cardioversion, or treatment with an increased dose of an antiarrhythmic drug within 3 to 12 months post-procedure. After a one-year follow-up, based in particular on the creation of an electrocardiogram (ECG) at 3, 6 and 12 months, 66.2% of patients with paroxysmal atrial fibrillation and 55% of patients with persistent atrial fibrillation meet the criterion. According to the researchers, these effectiveness rates are comparable to those achieved with thermal ablation procedures.
More specifically, 69.5% of patients with paroxysmal atrial fibrillation had no recurrence of cardiac arrhythmias after one year, compared to 62.3% of patients with persistent atrial fibrillation. The clinical success of the procedure, defined by the lack of recurrence of symptomatic arrhythmias, was observed in 79.7% and 80.8% of patients, respectively.
All patients reported an improvement in their quality of life. Regarding the safety profile, one cerebrovascular accident (CVA) was reported in each of the groups, corresponding to an adverse event rate of 0.7%. The tolerance threshold for the validation of the approach was set at 13%. No lesions of the esophagus, phrenic nerve, or pulmonary vein were reported.
The researchers believe that practical and technological developments could improve the results. Larger studies are needed to provide definitive evidence of the safety of the procedure. A randomized trial with a control group is also essential before validating this approach, they state.
“This technology has generated a lot of excitement among electrophysiologists. Many medical professionals believe that electroporation ablation will be the main method in the future. In that sense, it’s a real paradigm shift,” commented Dr. verma.
This is a real paradigm shift.
This article was published on Mediquality.net, a member of the Medscape network.
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