Experience of using system of irreversible electroporation for pulmonary vein isolation in patients with atrial fibrillation

Aim. To evaluate the effectiveness and safety of the use of the irreversible electroporation system for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Methods. The study included 25 patients with AF: 20 with paroxysmal (80%) and 5 with persistent (20%) forms. Among the participants, there were 16 men (64%), an average age of 58±9 years. All patients underwent PVI using pulsed field ablation (PFA), which leads to irreversible electroporation. Two patients (8%) underwent isolation of the cavotricuspid isthmus using PFA. To assess the safety of the procedure, laboratory diagnostics were performed to evaluate free hemoglobin and troponin I, and magnetic resonance imaging of the brain was performed before and after the procedure. In 3 months after procedure all patients underwent multi-electrode mapping of the left atrium and pulmonary veins to assess the PVI, and, if necessary, additional isolation using radiofrequency ablation. The follow-up period was 12 months. Results. PVI was achieved in 100% of cases. Isolation of the cavotricuspid isthmus before achieving a bidirectional block of conduction was successfully performed also with the same energy source. Among the complications, there was only 1 case related to vascular access. The average duration of the PFA catheter in the left atrium was 21.9±11.7 minutes, and the average fluoroscopy time was 11:23±5:41 min:sec. According to the results of repeated multi-electrode mapping, all pulmonary veins remained isolated in 22 patients (88%). After 12 months of follow-up, 19% (76%) of patients still had a sinus rhythm. Conclusion. Thus, the new national technology of irreversible electroporation has demonstrated its effectiveness and safety, comparable to traditional thermal techniques for pulmonary vein isolation in patients with AF.