Pulsed-field ablation for AFib not linked to any signs of bronchial damage

Pulsed-field ablation (PFA) is not associated with bronchial damage when used to treat paroxysmal atrial fibrillation (AFib), according to new findings published in Circulation: Arrhythmia and Electrophysiology.[1]

The study’s authors noted that other catheter ablation techniques have been found to cause “collateral damage to cardiac and extracardiac tissue, like the esophagus and the bronchus.” Is this also the case with PFA? So far, that remains to be seen.  

“Since 2018, several clinical studies have reported on efficacious and safe ablation using irreversible electroporation, also known as PFA, for pulmonary vein isolation in patients with paroxysmal AFib,” wrote first author Anna Füting, MD, with the department of electrophysiology at Alfried Krupp Hospital in Germany, and colleagues. “There are no preclinical or clinical data available [showing] whether PFA can cause bronchial damage.”

To learn more about this topic, Füting et al. examined data from two separate groups of 30 patients. PFA was performed on each patient using Boston Scientific’s FARAPULSE PFA system, which has not yet been approved by the U.S. Food and Drug Administration. Cardiac CT exams and bronchoscopy results from all patients were evaluated for the team’s analysis. A PFA catheter with a straight-tip guide wire was used for the first 30 patients, but a J-tip guide wire was used for the second set of 30 patients.

Overall, all PFA patients were asymptomatic after 30 days. No patients experienced chest discomfort, coughing or hemoptysis. No thermal lesions or ulcers were detected. Also, hemoglobin levels “remained clinically stable” for each patient.

Small amounts of old blood were seen in 40% of patients treated with a straight-trip guide wire, but there were no signs of active bleeding. No old blood was seen in patients treated with the J-tip guide wire.

“The distance between the bronchus and the ostium of the pulmonary vein can be as small as <5 mm,” the authors wrote. “Despite wide antral pulmonary vein ablation and ablation of the left atrial roof, no collateral bronchial damage was found in the present study. The unique properties of electroporation ablation make PFA a safe ablation modality for the bronchial system.”

Read the team’s full analysis in Circulation: Arrhythmia and Electrophysiology here.

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