Pulmonary Vein Stenosis after Catheter Ablation: Electroporation versus Radiofrequency
Background—Radiofrequency (RF) ablation inside pulmonary vein (PV) ostia can cause PV stenosis. A novel alternative method of ablation is irreversible electroporation, but the long-term response of PVs to electroporation ablation is unknown.
Methods and Results—In 10 six-month old pigs (60-75 kg), the response of PVs to circular electroporation and RF ablation was compared. Ten consecutive non-arcing, 200 joules (J) electroporation applications were delivered 5 to 10 mm inside one of the two main PVs, using a custom deflectable 18 mm circular decapolar catheter. Inside the other PV, circular RF ablation was performed using 30 watts RF applications via an irrigated 4 mm ablation catheter. PV angiograms were made before ablation, immediately after ablation and after 3 months survival. PV diameters and heart size were measured. With electroporation ablation, PV ostial diameter decreased 11±10% directly after ablation, but had increased 19±11% after 3 months. With RF ablation, PV ostial diameter decreased 23±15% directly after ablation and remained 7±17% smaller after 3 months than pre-ablation diameter despite a 21±7% increase in heart size during aging from 6 to 9 months.
Conclusions—In this porcine model, multiple circumferential 200 J electroporation applications inside the PV ostia do not affect PV diameter at 3-month follow-up. RF ablation inside PV ostia causes considerable PV stenosis directly after ablation, which persists after 3 months.
- electroporation ablation
- radiofrequency ablation
- catheter ablation
- pulmonary vein
- pulmonary vein stenosis
- Received September 24, 2013.
- Revision received April 30, 2014.
- Accepted May 11, 2014.